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THE
HOSPITAL STEWARD'S
MANUAL:
FOE, THE INSTRUCTION OF
HOSPITAL STEWARDS, WAED-MASTEES, AND ATTEND-
ANTS, IN THEIR SEVEEAL DUTIES.
PREPARED IN STRICT ACCORDANCE WITH EXISTING REGULATIONS,
AND THE CUSTOMS OF SERVICE IN THE ARMIES OF THE
UNITED STATES OF AMERICA,
AND RENDERED AUTHORITATIVE BY ORDER OP THE SURGEON-GENERAL.
JOSEPH JANVIER WOODWARD, M.D.
ASSISTANT SURGEON U.S.A., MEMBER OP THE ACADEMY OP NATURAL SCIENCES
OP PHILADELPHIA, ETC.
PHILADELPHIA:
J. B. LTPPINCOTT & CO.
1863.
Entered according to Act of Congress, in the year 1862, by "
JOSEPH JANVIER WOODWARD,
in the Clerk's Office of the District Court of the United States for the
District of Columbia.
PKEFACE.
The preparation of this little work was sug-
gested to the author by the Surgeon-General.
It was hastily written to supply an existing
want. Had it been otherwise, more time
would have been given to its composition, and
perhaps a more complete work would have
been the result. It is hoped, however, that it
will prove useful to surgeons as well as at-
tendants, and that it will be found a material
aid in the laborious duties of the Medical Staff
in hospitals and in the field.
J. J. Woodward,
Assistant Surgeon U.S.A.
Washington, Sept. 10, 1862.
OFFICIAL ORDERS.
Surgeon-General's Office,
Washington City, August 5, 1862.
Surgeons J. K. Barnes and J. E. Smith, U.S. Array,
are hereby appointed a Board to examine and re-
port upon a work entitled " The Hospital Steward's
Manual," presented by Assistant Surgeon J. J. Wood-
ward, U. S. Army.
"William A. Hammond,
Surgeon-General U.S.A.
Surgeon-General's Office,
"Washington City, August 19, 1862.
The Board having critically examined the work
presented by Assistant Surgeon J. J. "Woodward,
U.S.A., entitled " The Hospital Steward's Manual,"
report that this work is written in strict accordance
with the regulations of the army and the customs
of the service; that the book supplies a deficiency
which has been long feit ; and respectfully recom-
mend that it be adopted for the instruction of hos-
pital stewards, and as an authority in all military
hospitals in the United States.
Joseph K. Barnes,
Surgeon U.S.A.
Joseph B. Smith,
Surgeon U.S.A.
OFFICIAL ORDERS. 0
Surgeon-General's Office,
Washington City, September 10, 1862.
"The Hospital Steward's Manual," prepared by-
Assistant Surgeon J. J. Woodward, U.S. Army, hav-
ing been approved by a Board of Medical Officers, is
adopted as a guide to hospital stewards and other
attendants, and will be strictly adhered to by them in
the discharge of their duties.
William A. Hammond,
Surgeon-General U.S.A.
1*
CONTENTS.
PART I.— HOSPITAL ATTENDANTS.
PAGE
CHAP, I. — Hospital Stewards 13
Sec. 1. — The Rank of Hospital Stewards 13
" 2.— The Pay of Hospital Stewards 16
" 3. — The Enlistment and Appointment of Hospital
Stewards 17
" 4. — The Uniform of Hospital Stewards 25
CHAP. II. — Other Hospital Attendants 29
Sec. 1. — Enlisted Men as Hospital Attendants 29
" 2.— The Hospital Corps 32
" 3.— Female Nurses 38
" 4. — Laundresses 41
CHAP. III. — General Outjjne of the Duties of Stew-
ards AND OTHER HOSPITAL ATTENDANTS 42
Sec. 1. — Number of Stewards and other Attendants
allowed in Hospitals and in the Field 42
" 2. — Outline of the Duties of Stewards 43
" 3.— Outline of the Duties of Ward-Masters 47
" 4. — Outline of the Duties of Nurses 54
" 5. — Cooks and Laundresses 67
" 6. — Duties of Hospital Attendants in Battle 67
7
5 CONTENTS.
PART II.— DISCIPLINE, POLICE, AND GENERAL
SUPERVISION OF MILITARY HOSPITALS.
PAGE
CHAP. I. — General Discipline of Hospitals 77
Sec. 1.— Roll Calls 77
" 2.— Daily Order of Hospital Duties 78
" 3. — The Steward's Visits of Inspection 82
" 4. — Sunday Morning Inspection 83
" 5. — Muster of Hospital Attendants and of Soldiers
in Hospital absent from their Companies.. 84
" 6.— The Guard 92
" 7.— The Guard-House 93
" 8. — Rules and Regulations for the Government of
the Hospital 94
CHAP. II. — Police and General Supervision of Hos-
pitals 98
Sec. 1. — The Cleanliness of the Hospital 98
2.— Ventilation 101
3. — Warming 105
4.— Lighting 108
5.— The Latrine 110
6. — Baths and Lavatories 112
7. — The Wards of the Hospital, their Arrange-
ment and Administration 115
8.— The Office of the Hospital 121
9. — The Knapsack-Room 127
10.— The Laundry 129
11.— The Linen-Room 132
CHAP. III. — Admissions, Discharges, Deaths, etc 134
Sec. 1. — Admission of Patients 134
" 2. — Return to Duty, Transfer to other Hospitals,
Furloughs, Discharges, and Desertions 140
" 3.— Of Deaths 143
CONTENTS. 9
PART III.— FOOD AND ITS PREPARATION.
vi.au
CHAP. I. — Provision Returns, Hospital Stores, Pur-
* chases for the hospital, the hospital fund
and its Management 155
Sec. 1. — Preliminary 155
2.— The Ration 156
3. — Provision Returns 162
4. — Hospital Stores 166
5. — Purchases for the Hospital 166
6. — The Hospital Fund, its Management 172
7. — The Care of Provisions and Hospital Stores.. 179
CHAP. II.— Of the Diet-Table 183
Sec. 1.— Full Diet 184
" 2.— Half Diet 190
" 3.— Low Diet 191
" 4.— Extra Diet 192
" 5.— Specimen of Diet Table 193
" 6.— Diet Table for Field Hospitals 201
CHAP. III. — Of the Kitchen and its Management.... 203
Sec. 1. — General Management of the Kitchen 203
" 2. — Fires and Fuel in General and Post Hospitals 210
" 3. — Fires and Fuel in Camp Hospitals 214
CHAP. rV.— Cooking in Hospitals 219
Sec. 1. — General Remarks 219
" 2. — Receipts adapted to the Ordinary Diet in
Hospitals 222
" 3.— Receipts for Extra Diets 240
PART IV.— THE DISPENSARY.
CHAP. I. — General Arrangement and Management of
the Dispensary 263
Sec. 1. — Requisitions for Medical Supplies 263
10 CONTENTS.
PAQB
Sec. 2.— The Supply Table 267
" 3. — Semi-Annual Returns 267
" 4. — Arrangement of the Dispensary 270
" 5. — Care of Instruments 274
CHAP. II. — Hints on Pharmacy for Hospital Stew-
ards 278
Sec. 1. — Remarks on Prescriptions 278
" 2. — Compounding and Distribution of Prescrip-
tions 285
PART V.— HINTS ON MINOR SURGERY AND DRESS-
INGS FOR HOSPITAL STEWARDS.
CHAP. I.— On Dressings 297
Sec. 1. — General Preparations for Dressings 297
" 2. — On the Dressing of "Wounds 299
" 3. — On the Roller Bandage and its Applications 304
CHAP. II. — Operations in Minor Surgery, performed
by the Hospital Steward 313
Sec. 1. — Cupping 313
" 2.— Leeching 317
" 3.— Extraction of Teeth 319
" 4. — Injections..... 322
PART I,
HOSPITAL ATTENDANTS.
NOTE.
The hospital attendants authorized by law
may be enumerated as follows : —
1. Hospital Stewards.
2. Ward-Masters.
3. Nurses.
4. Female Nurses.
5. Cooks.
6. Laundresses. (Called also Matrons in
" Army Regulations.")
Each of these classes will be made the sub-
ject of separate remark.
12
THE
HOSPITAL STEWARD'S MANUAL.
CHAPTER I.
Hospital Stewards.
SECTION I. — THE RANK OF HOSPITAL STEWARDS.
The hospital steward is a non-commissioned
officer; he ranks with ordnance sergeants, and
next above the first sergeant of a company.*
He is therefore entitled by his rank to obedience
from all enlisted men who may be in the hos-
pital, whether patients, ward-masters, nurses,
or employes, who must cheerfully and promptly
comply with all his reasonable and lawful com-
mands. In his relations to the medical officers,
or to commissioned officers generally, however,
he must never forget that he is an enlisted
man, and owes prompt and ready obedience to
the lawful commands of his military superiors.
* Revised Regulations for the Army, 1861, Art. II, § 4.
2 13
14 THE HOSPITAL STEWARD'S MANUAL.
In all matters pertaining to discipline, the
military laws applying to the hospital steward
are the same as for any other soldier, and he
is bound, to the same extent, to comply with
army regulations, and with the articles of war.
For disobedience of orders, neglect of duty,
drunkenness, or any other military offence, the
hospital steward may be placed in arrest by
the commanding officer, or other competent
authority, and may be tried and punished by
court-martial, as in the case of other enlisted
men. A single exception in favor of the hos-
pital steward is intended especially for the
protection of those who originally enlisted as
such. It is laid down in the following regu-
lation : —
" The jurisdiction and authority of courts-
martial are the same with reference to hospital
stewards as in the cases of other enlisted men.
When, however, a hospital steward is sentenced
by an inferior court to be reduced to the ranks,*
such sentence, though it may be approved by
the reviewing officer, will not be carried into
effect until the case has been referred to the
Secretary of War for final action. In these
* That is, the rank of a private soldier.
THE HOSPITAL STEWARD'S MANUAL. 15
cases of reduction, the application of the man
for discharge from service, though not recog-
nized as of right, will generally be regarded
with favor, if his offence has not been of too
serious a nature, and especially when he has not
been recently promoted from the ranks."* It
is, however, provided that hospital stewards
are not to be tried by regimental or garrison
courts-martial, unless by special permission of
the department commander.-]-
Where several hospital stewards are serving
together, as frequently happens in the great
general hospitals, their relative rank is decided
by the seniority of their warrants, as in the
case of other non-commissioned officers. This,
however, is not construed to prevent the sur-
geon in charge from selecting the hospital
steward regarded by him as the most active
and efficient for the position of chief steward,
and confiding to his charge the general care of
the hospital. The chief steward is ex officio
the ranking steward for the time-being, and
must be obeyed and respected accordingly by the
other stewards, as well as by the ward-masters,
nurses, and patients.
* Revised Regulations, 1861, Art. XLIV. \ 1292.
t Revised Regulations, Art. XXXVIII. g 895.
16 THE HOSPITAL STEWARD'S MANUAL.
SECTION II. — THE PAY OF HOSPITAL STEWARDS.
The pay of a hospital steward appointed by
the Secretary of War was formerly that of an
ordnance sergeant, $22 a month, with one ra-
tion a day, and the clothing allowance of an
enlisted man. By an act of Congress of April
16, 1862, entitled "An Act to reorganize and
increase the efficiency of the medical depart-
ment of the army," the pay has, however, been
increased from $22 to $30 per month, which
is the present rate, the other allowances re-
maining the same.
In barracks he is entitled to one room
as quarters, to half a cord of wood monthly
from May 1 to September 30, and one cord
for each month from October 1 to April 30.
The ration is issued only in kind, and is not
commuted in money.
The clothing allowance need not be drawn
in full; and any savings in this respect are paid
to the steward in the final settlement of his
accounts.
Acting hospital stewards (see next section)
receive but $20 a month, except when serving
at posts of more than four companies, when
they receive $22 per month; their rations,
THE HOSPITAL STEWARD'S MANUAL. 17
clothing, allowances, &c. are the same as
stewards regularly appointed.
The steward is paid on a hospital muster
roll, on which are paid also the medical cadets,
female nurses, matrons, and all soldiers in
hospital, sick or on duty, who are detached
from their companies.
These muster rolls must be made out in
the forms furnished from the Adjutant-Gene-
ral's office, and according to the directions
expressed on them.*
The surgeon in charge is responsible for the
accuracy of the rolls, which must be signed by
him and the mustering officer.
Should he re-enlist, the hospital steward is
entitled to the same extra pay as other enlisted
men. (See next section.)
SECTION III. OF THE ENLISTMENT AND APPOINT-
MENT OF HOSPITAL STEWARDS.
Hospital stewards may be appointed from
the enlisted men of the army, or may be spe-
cially enlisted. The appointment is, in every
case, made by the Secretary of War.
* Sec Hospital Muster Roll, Part II. chap II. % 8.
2*
18 THE HOSPITAL STEWARD'S MANUAL.
Non-commissioned officers or soldiers may
be appointed hospital stewards, on the recom-
mendation of the senior medical officer of the
hospital, post, or command. This recommend-
ation must be endorsed by the company com-
mander, and the commanding officer of the
post or detachment, and forwarded by the lat-
ter to the Adjutant-General of the army.
"As the object of these more permanent
appointments is to procure the services of a
more competent body of hospital stewards, no
soldier, nor citizen, must henceforth be recom-
mended for appointment, who is not known to
be temperate, honest, and in every way relia-
ble, as well as sufficiently intelligent, and
skilled in pharmacy, for the proper discharge
of the responsible duties likely to be devolved
upon him."*
Hospital stewards may also be enlisted, as
such, from civil life. Applications, in the hand-
writing of the candidate, should be addressed
to the Surgeon-General, accompanied by testi-
monials as to character and competency. The
enlistment is for the term of three years.
At the expiration of his enlistment, should
* Revised Regulations, Art. XLiy. \ 1288.
THE HOSPITAL STEWARD'S MANUAL. 19
he desire it, the hospital steward may be re-en-
listed by the commanding officer, on the recom-
mendation of the medical officer. He is then
entitled, as are all enlisted men on re-enlist-
ing, to $2 per month additional pay, and $1
per month for each subsequent period of five
years' service, provided he re-enlists within
one month after the expiration of his term of
service. When enlisted men are appointed
hospital stewards, the appointment is for the
remaining unexpired term of service. When
enlisted men of the volunteer service are ap-
pointed hospital stewards in the regular army,
they must first be discharged from service.
In addition, it is provided, to meet the cur-
rent wants of the service, and especially of
troops in the field or distant posts, that the
commanding officer may, on the recommenda-
tion of the medical officer, detail a soldier to
act as temporary steward.
These temporary stewards are generally
designated as Acting Hospital Stewards. At
posts of more than four companies they receive
$22 per month and the allowances of hospital
steward; with smaller bodies of troops, the
pay and allowances of a sergeant of infantry.*
* $20 per month.- See act July 5, 1838, sec. 12.
20 THE HOSPITAL STEWARD'S MANUAL.
These temporary appointments may be
regarded as " affording the means of a careful
probation of all soldiers so detailed, who are
ambitious of one day deserving a permanent
appointment."*
The candidate for enlistment or appointment
as hospital steward should be not less than
eighteen nor more than thirty-five years of age.
He must be able-bodied and free from disease.
Previous to his enlistment he is inspected by
a medical officer, in the same manner as any
other recruit, and will be rejected if found
laboring under any disease or disability which
would reject a recruit. He should be of honest
and upright character, of temperate habits, and
good general intelligence. He must have a
competent knowledge of the English language,
and be able to write legibly and spell correctly.
This point must be satisfactorily ascertained
before he can be enlisted, as without this quali-
fication it will be impossible for him to keep the
books and records, or to attend to the general
business of the hospital. In addition, he must
have sufficient practical knowledge of pharmacy
to enable him to take exclusive charge of the
* Revised Regulations, Art. XLIV. § 1289, note.
THE HOSPITAL STEWARD'S MANUAL. 21
dispensary, must be practically acquainted
with such points of minor surgery as the appli-
cation of bandages and dressings, the extrac-
tion of teeth, and the application of cups and
leeches, and must have such knowledge of
cooking as will enable him to superintend
efficiently this important branch of hospital
service.
He should be industrious, temperate, patient,
and good-tempered, and actuated by an honor-
able desire to minister to the extent of his
ability to the necessities and comforts of the
sick and wounded soldiers who are placed
under his charge.
On receiving his appointment, the hospital
steward receives, from the office of the Adju-
tant-General, a warrant made out in the follow-
ing form :
22 THE HOSPITAL STEWARD'S MANUAL.
HOSPITAL STEWARD AT —
To all who shall see these presents, greeting :
Know ye, that this is to certify that , of
the Regiment of , having been recom-
mended as a fit person to receive the appointment of
Hospital Steward, the Secretary of War has selected him,
in conformity with the second section of the Act of the
16th of August, eighteen hundred and fifty-six, entitled " An
Act providing for a necessary increase and better organiza-
tion of the Medical and Hospital Department of the Army :"
And he is hereby appointed accordingly, with all the rights,
privileges, immunities, and allowances appertaining to said
appointment, and with the rank of a sergeant of ordnance.
He is, therefore, strictly charged carefully and diligently
to perform and execute all duties belonging to said appoint-
ment, in conformity with the rules and regulations of the
service. And he is to be respected accordingly.
Given at the , City of Washington,
this day of , 18 .
By command,
THE HOSPITAL STEWARD'S MANUAL. 23
" The accounts of pay, clothing, &c, of hos-
pital stewards must be kept by the medical
officers under whose immediate direction they
are serving, who are also responsible for certi-
fied statements of such accounts, and correct
descriptive lists of such stewards, to accompany
them in case of transfer; as also that their
final statements and certificate of discharge are
accurately made out, when they are at length
discharged from the service."*
The following is the form of the descriptive
roll and account of pay and clothing : —
* Kevised Keg., Art. XLIV. g 1293.
24 THE HOSPITAL STEWARD'S MANUAL.
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THE HOSPITAL STEWARD'S MANUAL. 25
SECTION IV. OF THE UNIFORM OF HOSPITAL
STEWARDS.
The hospital steward should always wear
his undress uniform in the hospital, except on
those occasions, such as musters and inspec-
tions, on which it is necessary for him to ap-
pear in full dress. This point is of more
importance than at first sight appears. The
strictest military discipline is absolutely neces-
sary in a military hospital; and it will be too
generally found that an unmilitary neglect of
regulations in regard to dress coexists with a
general neglect of discipline and regulation in
regard to other duties.
The uniform of the hospital steward u for
fatigue purposes" that is, for all ordinary duties,
consists of the blouse, or sack-coat, and trousers,
prescribed by regulations for all foot soldiers.
The trousers are to have upon the outer seam
of each leg a stripe of crimson worsted lace,
one and one-half inch wide. It is advisable
that the half chevron described for the full
uniform of the hospital steward should also
be worn upon the undress coat. He should
take enough pride in his personal appearance
26 THE HOSPITAL STEWARD'S MANUAL.
to keep his clothes neat and his boots clean
and well blacked.
The undress cap is the regulation forage cap,
similar to that of other enlisted men.
The full uniform of a hospital steward con-
sists of —
1. Uniform coat, which is a dark-blue cloth
single-breasted frock, the same as that pre-
scribed by army regulations for all enlisted foot
men; except that the cord or welt of cloth
which edges the cuffs and collar is crimson,
instead of being sky-blue as for infantry, or
yellow as for engineers.
2. Trousers of dark-blue cloth, with a stripe
of crimson lace one and one-half inch wide
down and over the outer seam.
3. Hat, a black felt hat, the same as that of
all enlisted men. The cord of buff and green
mixed, the wreath in front of brass, with the
letters U. S. in Roman, of white metal. Brim
to be looped up to side of hat with a brass
eagle, having a hook attached to the bottom
to secure the brim. The feather to be worn
on the side opposite the loop.
3. Cravat or stock, black leather, the same as
that of all enlisted men.
THE HOSPITAL STEWARD'S MANUAL. 27
4. Boots or shoes, the same issued to all en-
listed men.
5. Sash, "red worsted sash, with worsted
bullion fringe ends; to go twice around the
waist, and to tie behind the left hip, pendent
part not to extend more than eighteen inches
below the tie."
6. Sword belt and plate, the same as for all
non-commissioned officers.
7. Sword, the same as for non-commissioned
officers.
8. Chevrons, " a half chevron of the follow-
ing description, viz.: of emerald-green cloth,
one and three-fourths inches wide, running
obliquely downward from the outer to the
inner seam of the sleeve, and at an angle of
about thirty degrees with a horizontal, parallel
to and one-eighth of an inch distant from both
the upper and lower edge, an embroidery of
yellow silk one-eighth of an inch wide, and in
the centre a 'caduceus' two inches long, em-
broidered also with yellow silk, the head
towards the outer seam of the sleeve."*
To indicate service, the additional half
chevrons allowed for all non-commissioned
* Revised Reg., Art. LI. \ 1553.
28 THE HOSPITAL STEWAKD'S MANUAL.
officers, viz., at the expiration of five years'
service, a diagonal half chevron one-half an
inch wide, to be worn upon both sleeves of the
uniform coat, below the elbow, extending from
seam to seam, the front end nearest the cuff,
and one-half an inch above the point of the cuff,
to be of the same color as the edging on the
coat (crimson) . In like manner, an additional
half chevron, above and parallel to the first,
for every subsequent five years of faithful
service. Distance between each chevron, one-
fourth of an inch.
Overcoat, the same as for enlisted men.
Gloves. — On full-dress occasions, white cotton
gloves should be worn.
Scales. — On each shoulder of the uniform
coat is worn a metallic scale, the same as worn
by all non-commissioned officers and enlisted
men.
THE HOSPITAL STEWARDS MANUAL. 29
CHAPTER II.
Other Hospital Attendants.
Besides the stewards, the following classes
of hospital attendants may be enumerated :
enlisted men, civilians, the hospital corps,
female nurses, and laundresses (matrons of
army regulations).
The male attendants were formerly all en-
listed men, detailed for the duty by the com-
manding officer on the recommendation of the
surgeon.
Recently, however, the Secretary of War
has authorized the employment in certain cases
of civilians as cooks and nurses, in general
hospitals only ; and thus a new body of hos-
pital attendants has been created, which is
designated the " Hospital Corps."
SECTION I. OF ENLISTED MEN AS HOSPITAL
ATTENDANTS.
Enlisted men selected as hospital attendants
may be either non-commissioned officers or
3*
30 THE HOSPITAL STEWARD'S MANUAL.
private soldiers. It is usual for non-commis-
sioned officers to be employed as ward-masters,
or in some similar responsible positions, only,
and private soldiers for all other duty.
In either case, the enlisted man, besides his
ordinary pay and emoluments, is entitled to
twenty-five cents daily "extra duty pay," which
is paid by the paymaster on a roll made out by
the surgeon, after the form on p. 31.
The pay and emoluments of these enlisted
men as soldiers are obtained from the pay-
master, on their descriptive lists, or on the
hospital muster roll, duly made out by the
surgeon, on forms furnished from the Adjutant
General's office.*
The distribution of these attendants as cooks,
nurses, &c, and the assignment to each of his
duties, is made by the surgeon.
Enlisted men thus employed are under the
orders of the surgeon, to whom they are to
look up as their commanding officer. They
are also under the orders of the hospital
steward, to all whose lawful commands they
must yield prompt obedience. They are ex-
empt from all other duty, but "shall attend
the parades for muster and weekly inspections
* See Part II. Chap. I. Sect. 5.
THE HOSPITAL STEWARDS MANUAL.
31
sJ j
I' I '
— — I
S5-
_ o
52
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p »-<j
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Regiment.
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3 o^
CD P
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CD
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No. of days.
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8- P
P2
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32 THE HOSPITAL STEWARD'S MANUAL.
of their companies at the post, unless specially
excused by the commanding officer."*
Sobriety, intelligence, and cheerful obedi-
ence to all lawful commands are indispensable
qualifications for hospital attendants, and those
who show capacity and industry are generally
selected by the surgeon for promotion to the
higher grades of ward-master and steward.
SECTION II. OF THE HOSPITAL CORPS.
Civilians may be employed as hospital at-
tendants by the Surgeon-General, and by such
surgeons as have received from him the neces-
sary authority. Their pay, emoluments, and
the regulations adopted with regard to them
are duly set forth in the following circular
issued by the Surgeon-General on the subject: —
OIEOULAE JTo. 4.
Surgeon-General's Office, June 5, 1862.
The Secretary of War having authorized in
certain cases the employment of civilians as
cooks and nurses for duty in general hospitals,
(only,) the following rules and instructions are
published for the information of all concerned :
* Revised Reg., Art. XLIV. § 1257.
THE HOSPITAL STEWARD'S MANUAL. 33
Regulations for the Hospital Corps of the United
States Army.
The men of the hospital corps will each
receive $20 50 per month, besides clothing,
rations, and medical attendance.
They will be under military discipline, and
subject only to the orders of the medical
authorities, and will wear the undress uniform
of a private soldier, with a green half chevron
on the left fore-arm.
Their duties will be either nursing the sick
and wounded of the army in hospitals, cook-
ing, or any other duties with the sick, at the
discretion of the medical officers.
They will be divided into squads of eleven,
one of whom will be responsible for the effici-
ency of the rest. One squad will be allowed
to every one hundred patients.
At the usual roll-calls, the chief of the squad
will answer for the rest to the hospital steward,
who will thus learn the number of vacant beds
in each ward, and all other particulars con-
cerning the condition and wants of the hospital,
which he will report to the medical " officer of
the day." The term of the service of the hos-
34 THE HOSPITAL STEWARD'S MANUAL.
pital corps will be according to the necessities
of the service, or during good conduct.
The amount of pay and clothing received by
each nurse, with date, will be recorded on their
contract, which will be as a descriptive list to
go with the nurse.
The senior medical officer in charge will
make a monthly pay-roll of the hospital corps
similar to Form 12, Medical Regulations, ex-
cept the rank and designation, and transmit
the same for payment to the nearest medical
disbursing officer.
Surgeons in charge of general hospitals,
when so authorized, may make contracts with
persons for such service according to the pro-
visions set forth herein.
William A. Hammond,
Surgeon- General.
Note. — It is hereby enjoined upon all medical officers that
they shall not avail themselves of this special authority of the
War Department without first receiving permission of the Sur-
geon-General to do so, on making a full statement of the facts
in the case, and clearly setting forth the reasons why the per-
mission should be granted, except in cases of immediate neces-
sity and urgency, and then the commanding officer must
approve. In such exceptional cases the facts will be promptly
reported to the Surgeon-General with the necessary explana-
tions, together with a request that permission be given to con-
tinue the employment if the necessity still exists.
THE HOSPITAL STEWARD'S MANUAL. 35
Civilians employed should possess the phy-
sical qualifications necessary for recruits. They
should be of good general intelligence, temper-
ate and industrious habits, and should be fully
imbued with the idea of the importance of their
calling, and of the responsibility of the duties
which they assume.
The same strict obedience is exacted from
them as from enlisted men.
Civilians employed as nurses or cooks are
contracted with by the officer employing them,
in accordance with the following form : —
Form of Contract with a Civilian, to act as
Hospital Attendant.
I, , hereby agree to serve in
the army of the United States, in the capacity
of nurse, and to perform such other duties in
connection with the sick and wounded of the
army as may be required of me by the medical
authorities, and to obey all orders emanating
from them; said service to continue for the
period of one year, unless sooner discharged ;
and I will accept, in payment for said service,
$20 50, besides clothing, rations, and medical
attendance, for each and every month I shall
36 THE HOSPITAL STEWARD'S MANUAL.
continue to perform the services above stated;
and I further agree that $2 shall be retained
from my monthly pay till this contract ceases.
. [seal.]
Signed, sealed, and delivered )
in presence of j
. [SEAL.]
They are paid by a medical disbursing offi-
cer, on a roll made out by the surgeon, in the
same form as that for enlisted men,* except
that the columns for rank, regiment, and com-
pany are omitted. The following is the form
employed : —
* See sect. 1 of this chapter.
THE HOSPITAL STEWARDS MANUAL.
37
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38 THE HOSPITAL STEWARD'S MANUAL.
SECTION III. OF FEMALE NURSES.
Female nurses are employed in general hos-
pitals, at the discretion of the surgeon in
charge, or of the Surgeon-General. Their pay
is 40 cents and one ration daily, with quarters
and fuel. The ration may be either com-
muted or drawn in kind.
They are paid on the hospital muster roll,
with the stewards, cadets, &c*
It will generally be found convenient, where
female nurses are employed, for the surgeon to
appoint the most intelligent and reliable to be
the directress of female nurses, whose duty it
shall be to supervise, to oversee the washing
and the distribution of clean clothes, the linen-
room and its appurtenances, the issue of deli-
cacies for the sick, and the extra-diet kitchen
for their preparation.
In the performance of these duties, she
should heartily co-operate with the steward,
and strictly obey the orders of the medical
officers.
The remaining female nurses will in every
case have their special duties designated,
* See Hospital Muster Koll.
THE HOSPITAL STEWARD'S MANUAL. 39
through the directress, by the surgeon in
charge; they may be conveniently assigned
to the care of the cleanliness of patients as to
dress and person, the supervision, prepara-
tion, and administration of extra diets and
beverages, and such watching and other care
of the sick as the medical officers may direct.
In addition, one or more nurses may be em-
ployed in the linen-room, in mending and
taking care of clothing, &c. &c.
Women employed in this capacity should be
intelligent, industrious, and of irreproachable
character. They should have a just apprecia-
tion of the importance of their duties, and
should devote themselves heartily to their
proper performance.
During the present war, great exertions have
been made to supply female nurses of the
proper character to military hospitals, by Miss
D. L. Dix, so well known for her philanthropic
endeavors to ameliorate the condition of the
insane. Miss Dix has been authorized by the
War Department to employ female nurses for
army hospitals ; and, as it is impossible for her
to supervise in person all the hospitals, she is
authorized to delegate her authority to subor-
dinate agents, not to exceed one for each city
40 THE HOSPITAL STEWARD'S MANUAL.
or military district. Women wishing employ-
ment as nurses must apply to Miss Dix, or to
her authorized agents, and medical officers
requiring women nurses are directed by the
Surgeon-General to apply to Miss Dix, or to her
authorized agent for the place where their
hospitals are located.
Exception is made to this rule only in cases
of urgent need.
Female nurses thus employed may be dis-
charged by the medical officer in charge of the
hospital to which they are assigned, if found
incompetent, insubordinate, or otherwise unfit
for their vocation.*
Besides the nurses furnished by Miss Dix,
Sisters of Charity, and the members of other
religious orders, have largely volunteered for
the duty of nurses during the present war, and,
by their devotion, strict obedience to direc-
tions, and irreproachable lives, have proved of
the greatest service to those hospitals which
have been fortunate enough to secure their
services. They can be employed only under
special instructions from the Surgeon-General's
office.
* See Circular No. 7, Surgeon-General's Office, Washington,
D.C., July 14, 1862.
THE HOSPITAL STEWARD'S MANUAL. 41
SECTION IV. OF LAUNDRESSES.
The laundresses for the hospital (matrons of
army regulations) are employed by the surgeon
at the rate of one to every twenty patients.
Their pay is six dollars a month, with one
ration per day.
They are paid on the hospital muster roll.
(F. 2.) Soldiers' wives are selected for this
duty wherever practicable. Where the laun-
dresses come to the hospital to wash, the hours
of work are regulated by the surgeon ; where
the clothes are given out to wash, the time
allowed for their completion is regulated by
the same authority.
4«
42 THE HOSPITAL STEWARD'S MANUAL.
CHAPTER III.
General Outline of the Duties of Stewards and other
Hospital Attendants.
SECTION I. NUMBER OF STEWARDS AND OTHER
HOSPITAL ATTENDANTS ALLOWED IN HOSPITALS
AND IN THE FIELD.
The number of hospital attendants is fixed
by army regulations as follows :
" Ordinarily, hospital attendants are allowed
as follows : to a general hospital, one steward,
one nurse as ward-master, one nurse to ten
patients, one matron to twenty, and one cook
to thirty ; to a hospital where the command
exceeds five companies, one steward and ward-
master, one cook, two matrons, and four
nurses ; to a post or garrison of one company,
one steward and ward-master, one nurse, one
cook, and one matron, and for every two
companies more, one nurse ; at arsenals, where
the number of enlisted men is not less than
fourteen, one matron is allowed.
" The allowance of hospital attendants for
troops in the field will be : for one company,
THE HOSPITAL STEWARD'S MANUAL. 43
one steward, one nurse, and one cook; for
each additional company, one nurse; and for
commands of over five companies, one addi-
tional cook."*
It will be observed that the word ordinarily
is used in connection with this regulation ; and
practically, in general hospitals and elsewhere,
when any special circumstances render a larger
number of attendants necessary, they can gene-
rally be obtained by the surgeon on repre-
senting the case to the medical director.
Thus, for example, in general hospitals of
more than one hundred and fifty patients,
more than one hospital steward is usually
allowed.
SECTION II. — OUTLINE OF THE DUTIES OF HOSPITAL
STEWARDS.
In the field, in post hospitals, and in
general hospitals of moderate size, but one
steward is generally allowed. His duties
embrace all those described in this work as
belonging to hospital stewards. He has,
under the surgeon, the general supervision
of the hospital, regulates its police, discipline,
* Revised Reg., Art. XLIV. § 1258.
44 THE HOSPITAL STEWARD'S MANUAL.
ventilation, lighting, and warming, attends to
the provision returns, carries out the surgeon's
instructions as to the management of the hos-
pital fund, makes the purchases for the hospi-
tal and takes care of the stores, sees that the
cooking is properly executed, the property of
the hospital duly cared for, and, in fact, is
responsible to the surgeon for the general
administration of the institution.
Besides these duties, he takes charge of
the dispensary, puts up the prescriptions, and
performs all those duties described in the
chapter on the dispensary and its manage-
ment, as well as renders to the surgeon such
assistance as may be necessary in dressings
and minor surgery.
These duties, however, are so extensive
that during the present war it has been found
expedient to authorize more than one steward
in general hospitals of a hundred and fifty
patients or upwards.
Where two hospital stewards are thus as-
signed to a general hospital, one should be
put in exclusive charge of the dispensary, and
should relieve the other of all except the
strictly administrative duties of the house.
Where three hospital stewards are assigned
THE HOSPITAL STEWARD'S MANUAL. 45
to a general hospital, one should be put in
charge of the cooking department. His duty
should be to supervise the cooks and all per-
taining to the kitchen, to receive and take
charge of the provisions when they arrive at
the hospital, and be responsible for their
economical use. One should have charge of
the dispensary, &c, and a third attend to the
administrative duties of the house.
Where more than three hospital stewards
are allowed, an additional steward may be de-
tailed for the dispensary, another to assist in the
administrative duties of the house, and so on.
As a general rule, three hospital stewards
will be found quite sufficient for hospitals of
five hundred patients.
The hospital steward charged with the ad-
ministrative duties of the house is designated
the chief steward. He receives obedience
from all non-commissioned officers, enlisted
men, and citizen nurses in the hospital, and
is immediately responsible to the surgeon in
charge for the performance of his duties.
The details of the several duties of hospital
stewards will be found throughout the volume.
In addition to these duties, there is a special
duty directed in regulations, to which the
46 THE HOSPITAL STEWARD'S MANUAL.
attention of hospital stewards is especially
called, because of late it has been too much
neglected, and great inconvenience has resulted
in consequence.
It is provided in regulations that " hospital
stewards, whenever stationed in places whence
no post return is made to the Adjutant-Gene-
ral's office, or when on furlough, will at the
end of every month report themselves by letter
to the Adjutant-General and Surgeon-General,
as well as to the medical director of the mili-
tary department in which they may be serv-
ing ; to each of whom they will also report
each assignment to duty, or change of station,
ordered in their case, noting carefully the
number, date, and source of the order direct-
ing the same. They will also report monthly
when on furlough to the medical officer in charge
of the hospital to which they are attached."*
Careful compliance with this regulation will
save much inconvenience to the steward, as
well as to the authorities. It is the only con-
venient way of knowing the whereabouts of any
individual steward. It is therefore urged upon
their attention, not merely as a military duty,
but as a matter of convenience to themselves.
* Kevised Reg., Art. XLIV. § 1292.
THE HOSPITAL STEWARD'S MANUAL. 47
SECTION in. OUTLINE OF THE DUTIES OF THE
WARD-MASTER.
The duties of the ward-master are, to a cer-
tain extent, described in arnry regulations, in
which it is ordered that the surgeon " will re-
quire the ward-master to take charge of the
effects of the patients; to register them in a
book; to have them numbered and labelled
with the patient's name, rank, and company ;
to receive from the steward the furniture, bed-
ding, cooking-utensils, &c. for use, and keep a
record of them, and how distributed to the
wards and kitchens; and once a week to take
an inventory of the articles in use, and report
to him any loss or damage to them, and to
return to the steward such as are not required
for use."*
It will be seen here that two duties are
specially assigned to the ward-master. First,
the care of the effects of patients. Second,
the care of the hospital furniture and utensils.
In order that the ward-master may take
charge of the effects of patients, he has assigned
to him the care of the knapsack-room.*{*
* Revised Reg., Art. XLIV. § 1246.
t See Part II. Chap. II. Sec. 9.
4S THE HOSPITAL STEWARD'S MANUAL.
On the reception of patients, their effects are
at once turned over to the ward-master, ex-
cepting only money, watches, or other valu-
ables, which are given to the surgeon for safe
keeping.
The ward-master examines them, makes a
list on the back of the patient's ticket, and
enters all in a book kept for the purpose, in
accordance with the form on p. 49.
After entering the list of articles in his book,
the ward-master will cause them to be neatly
packed in the knapsack, have the overcoat and
blankets properly folded and strapped upon it,
and affix to the package a label, on which is
written the name, rank, and company of the
owner, with the number of his ward and bed.
It is then to be carried to the knapsack-room
and placed upon the appropriate shelf.
Muskets, sabres, pistols, &c. are to be simi-
larly labelled and placed on the arms-rack in
the knapsack-room.
When the patient leaves the hospital, his
effects are to be duly returned to him, except
when he is discharged from service, in which
case arms and other United States property
are to be retained by the ward-master, the
government property thus accumulating in the
THE HOSPITAL STEWARDS MANUAL.
49
No.
3
p
I
fed
a
ft
2S
•a a
a, a
Company.
Coats.
Jackets.
Overalls.
&c.
Muskets.
Knapsacks.
&c.
&c.
&c.
N
pj
Remarks will note
to whom the articles
were delivered, what
money, &c, were left
by those who die;
and to whom they
were given.
1
50 THE HOSPITAL STEWARD'S MANUAL.
hospital to be turned over from time to time,
on orders received from the surgeon, to the
Ordnance department.
When the patient dies in hospital, the ward-
master is to furnish the surgeon with a state-
ment of his effects, copied from his account-
book, and is to retain them in his possession
until he receives orders from the surgeon as to
their disposition.*
Where no legal claimant appears for pro-
perty accumulating, either from deceased or
deserted soldiers, or from sources unknown, it
is to be retained until orders are received for
its disposition from proper authority.
In order that the ward-master may properly
care for the hospital furniture for which he is
responsible, he must keep a record of it, and
of its distribution to the office, wards, kitchen,
&c. &c.
This record is kept in accordance with the
following form : —
* Revised Regulations, Art. XVII.
THE HOSPITAL STEWARDS MANUAL.
51
1
No. of ward or kitchen.
1
Bunks.
Bedsacks.
Sheets.
Blankets.
Kettles.
Spoons.
Knives.
Forks.
&c.
&c.
Lost.
Worn out.
Destroyed by order.
Beturned to steward.
The remarks will
state how articles have
been lost, and by whom
destroyed, or the per-
sons suspected, &c.
1
00
52
THE HOSPITAL STEWAKD S MANUAL.
The above is the form suggested in regula-
tions. The following form, however, will be
adopted as more convenient in large hospitals.
Each page of a small blank-book is to be
devoted to a separate ward, kitchen, office, or
other apartment, and is to be ruled in accord-
ance with the following form : —
Ward No.
oV
o
a
u
o
13 £
Names of articles.
a
3
o
1-3
° o
ft"0
Remarks.
Here enter the
The remarks to
names only of ar-
state how articles
ticles of furniture
have been lost, and
actually in the
by whom destroyed,
apartment.
or the person sus-
pected.
Each page is to be headed with the name
of the ward or apartment to which it belongs.
In making out the original inventory, or re-
cording the original issues, the names of those
articles only are to be entered which are
THE HOSPITAL STEWARD'S MANUAL. 53
actually in the apartment concerned, leaving
the rest blank to record subsequent additions.
The chief nurse, cook, or other attendant in
charge of a ward or apartment, should be fur-
nished with a copy of the ward-master's inven-
tory for his particular ward. As the ward-
master is responsible for the due preservation
of all the hospital property, so, in like manner,
is the chief nurse or other attendant, in charge
of a particular apartment, responsible to the
ward-master for the articles intrusted to his
care, as set forth in the inventory furnished
him.
Once every week the ward-master is to go
over the hospital with his book, and to com-
pare the list for which each ward, &c. is re-
sponsible, with the articles actually present.
All articles not needed for current use are to
be returned to the steward. Loss or damage
is to be duly reported to the surgeon.
In a hospital of considerable size, the ward-
master may need assistance in the perform-
ance of these duties; in which case, one or
more hospital attendants may be designated
by the surgeon in charge as assistant ward-
masters.
5*
54 THE HOSPITAL "STEWARD'S MANUAL.
SECTION IV. — OUTLINE OF THE DUTIES OF NURSES.
The duties of nurses are the same, whether
they belong to the hospital corps or are
enlisted men temporarily detailed for the pur-
pose.
Each ward has its nurses specially assigned
to it by the surgeon in charge. One of these
is designated by him as the chief nurse, who
is held responsible by the ward-master for the
care of the furniture, utensils, and other hos-
pital property, and by the steward for the
discipline, police, and general administration
of the ward.
At the option of the surgeon, a female
nurse may be assigned to this duty.
The chief nurse will see that the beds are
duly made up in the morning; that chamber-
pots, bed-pans, and urinals are emptied when-
ever used; that the ward is properly swept
and cleaned daily; that the meals of those
patients who are confined to . bed are fur-
nished them at the proper hour; that those
patients who go to the common table are as-
sembled at the dinner-hour, to march, to the
dining-hall; that the medicines are sent for
THE HOSPITAL STEWAKD S MANUAL. 55
when notification of their readiness is received
from the dispensary; that they are admi-
nistered to the patient ; that the ward is pro-
perly ventilated, free from all close or un-
pleasant odors, properly lighted at night, and
in the winter-time properly warmed ; and that
all the police regulations established by the
surgeon in charge are scrupulously complied
with. He will maintain order and discipline
among the attendants and patients, and report
all neglect of duty, disobedience of orders,
absentees, &c, to the steward.
He will attend the several roll-calls, and
there make to the steward report of the con-
dition of the ward, of absentees, &c.
When the surgeon visits the ward, he will
accompany him from bed to bed with a slate
or memorandum-book, in which he will note
the diet, directions as to the administration of
medicine, and other specific directions with
regard to each patient; and he will be held
responsible that these directions are properly
carried out.
These duties are responsible and important,
and require sobriety, fidelity, and intelligence
on the part of the attendant to whom they are
intrusted. Too great care cannot, therefore,
56 THE HOSPITAL STEWARD'S MANUAL.
be exercised in the selection of the chief nurse,
who should be at once degraded by the sur-
geon if he proves incompetent or negligent.
In small wards of ten or fifteen beds, the
chief nurse may, in addition to these duties,
assume the care of a share of the patients. In
wards of twenty beds and upwards, however,
it will be found advisable to assign to him
only the general supervision and responsibility
above outlined.
The beds in each ward are to be divided
equally among the remaining nurses, each of
whom is to be responsible for all that pertains
to those placed under his charge.
He will see that convalescents who are able
make their beds immediately after rising in
the morning, and will himself make those beds
whose occupants are unable to do so. Where
patients are confined to bed, their beds should
likewise be carefully made up daily, or oftener
when their comfort requires it.
Where the patient is able, he may rise from
the bed and sit in a chair, or lie in an adjacent
bed, as the case may be, while his bed is being
made. But where this is impossible, as in
severe cases of fevers, wounds with fractures,
&c, the making of the bed becomes a matter
THE HOSPITAL STEWARD'S MANUAL. 57
of some difficulty as well as of importance.
To neglect it, besides rendering the patient
uncomfortable, would be to make cleanliness
impossible, and to predispose to excoriations
and to bed-sores. But caution is necessary in
executing the task. The pillow may be re-
moved from under the head, shaken up, the
case changed when necessary, and replaced.
The bed-covers may be removed, the bottom
sheet smoothed, drawn upon first on one side
and then on the other, so as to remove wrin-
kles, all crumbs, &c. which may have accumu-
lated on it brushed away, and then the upper
sheet, blankets, and coverlet replaced neatly
and rapidly.
Where it is necessary to change the bottom
sheet, this may readily be done by pinning the
clean sheet to the margin of the dirty one, so
that as the one is gently drawn away the
other is carried into place. The pins should
be placed with their heads towards the direc-
tion in which the sheet is to be drawn ; other-
wise their points are liable to catch in the
mattress, or the clothes and flesh of the patient.
In cases of fractures of the lower extremi-
ties, and other severe injuries, where harm
might result from an incautious movement,
58 THE HOSPITAL STEWAKD'S MANUAL.
this duty should only be performed in the
presence of the attending surgeon.
The nurse is also immediately responsible
for the personal cleanliness of the patients
under his charge. He will see that, when they
are able to do so, they wash themselves daily,
and change their under-clothes at least once a
week. Where the patient is unable to wash
himself and change his clothes, these duties
must be performed for him by the nurse.
The nurse must therefore daily wash the
hands and faces and comb the hair of those
patients who are unable to wait on themselves.
This duty should be performed gently and
thoroughly, and without spilling water upon
the bed or floor. Where patients are long
confined to bed, as in cases of fractures, the
feet, limbs, and body should also be washed
from time to time. A sponge will be found
useful in these cases, both in applying soap
and in subsequently removing it.
General sjDonging of the body should not,
however, be resorted to in fevers or other
acute diseases, except with the permission of
the surgeon. Where patients are obliged to
use the bed-pan, urinal, or chamber-pot or
chair, the nurse should furnish it to them on
THE HOSPITAL STEWARD'S MANUAL. 59
the want being made known, and immediately
after it is used carry it out of the ward, empty
it, cleanse it, and restore it to its place. On
no account should vessels containing excre-
ment or urine be allowed to remain even for a
few minutes in the ward.
Attention to this particular is so indispensa-
ble in a sanitary point of view, that the chief
nurse should hold each nurse strictly respon-
sible for the faithful performance of the duty.
Where, from involuntary evacuations of
urine or feces, the patient soils his clothes or
his bed, as frequently happens in low forms of
fever, in injuries accompanied by paralysis,
&c, they should be immediately changed. For
the same reason, a piece of oiled silk, oil-cloth,
or gutta-percha cloth, should be introduced
between the sheet and the mattress, in cases
where such an accident may be anticipated, to
protect the mattress from injury.
In suppurating wounds, or in cases where
water dressings are applied, a piece of oiled
silk or gutta-percha cloth should always be
employed to protect the bedclothes.
Bedclothes stained with pus or blood should
be immediately changed, and economy is to be
consulted by protecting the bedclothes and
60 THE HOSPITAL STEWARD'S MANUAL.
clothes of the patient from being soiled, and
not by retaining foul linen, &c. about him to
avoid frequent changes. Absolute cleanliness
is indispensable to secure the health of wards.
Another point of importance is, to see that
patients are kept free from lice and other ver-
min. This is, to a great extent, secured by
attention to personal cleanliness. But some
other points may be mentioned.
Bedbugs are best avoided by cleanliness of
the beds, secured by occasional wiping with
soap and water, especially in all joints and
crevices. They are less likely to be found in
iron bedsteads, where the mattress rests on
wooden or iron slats, than in wooden cots with
sacking-bottoms : where they exist, they may
be destroyed by washing the crevices with a
solution of corrosive sublimate in alcohol, after
destruction of all visible on search.
Lice may be removed by the use of the fine-
toothed comb, of strong soap and water, and,
where necessary, of weak mercurial ointment,
or of ointment or infusion of fish-berries,
( Gocculus indicus, one drachm of the powder to
the ounce of lard, or one ounce to the pint of
boiling water.) Infusion or tincture of nux
vomica also answers the same purpose.
THE HOSPITAL STEWARD'S MANUAL. 61
These medicinal agents, however, should
never be resorted to without the consent of the
surgeon ; and where infusion of fish-berries, or
of nux vomica, is employed, the greatest care
should be exercised that it is not accidentally
employed internally, as it is a deadly poison.
It is also the duty of the nurse to admi-
nister the medicines to the patients, and in
other respects to carry out the directions of
the surgeon. He should, therefore, with the
chief nurse, accompany the surgeon in his
visits to the patients under his care, and
either himself write upon a slate or in a
memorandum-book the surgeon's directions for
each, or should have free access to the book
of the chief nurse in which this record is made.
The nurse should remember that absolute
obedience in these respects is his military
duty, and that every time he disobeys or
neglects the surgeon's directions as to the
care of the patient in any particular, he risks
unnecessarily the life of a fellow-creature. It
is not for him to judge of the propriety or
importance of the measures directed : for this
the surgeon is responsible : blind and complete
obedience is necessarily required of him, and
for this he will be held strictly responsible.
62 THE HOSPITAL STEWARD'S MANUAL.
The nurse will also see that those of his
patients go to the common table for their
meals who are authorized to do so by the
surgeon, and these only. He will distribute
to the others the diet allowed for each by the
surgeon, and, where the patient is unable to
feed himself, will with his own hands admi-
nister the food in accordance with directions
received. The same obedience to the sur-
geon's orders is required here as in the admi-
nistration of remedies, and for the same reason.
The nurse cannot know in any case how fatal
may be the results of neglect or disobedience.
It will be seen that for the proper perform-
ance of these duties the nurse should in every
case be able to read and write.
In addition to the special duties which each
nurse owes to the patients under his charge,
there are certain general duties in every ward,
which are distributed among the nurses, each
of whom is to be held responsible for the due
performance of the duties assigned him.
Thus, to one should be assigned the sweep-
ing and cleaning of the floor, walls, and win-
dows, to another the maintenance of the fires
and the superintendence and management of
THE HOSPITAL STEWARD'S MANUAL. 63
the lights, to a third the cleanliness of the
bath-room, lavatory, and water-closets attached
to the ward, &c.
Two or more nurses are to be detailed daily
to carry food from the kitchen to the ward,
one or more to bring the medicines from the
dispensary to the ward, two or more to relieve
each other on duty as night nurses where
these are required by the emergency of par-
ticular cases or the general directions of the
surgeon.
The chief nurse, with the permission of the
surgeon, may make this distribution of duty,
and should keep in a memorandum-book a
list of the attendants under his orders, with
the duties assigned to each, in order that no
disputes may arise as to who is responsible for
any of the business of the ward.
Night nurses may be either the ordinary
attendants of the ward detailed in turn for
that purpose, or a special set of attendants or
night watchers detailed for that duty only.
In a great institution, the latter is the best
plan. One night nurse should be assigned to
each ward, and one to the general supervision
of the whole house, whose duty it shall be
to go over the house every hour during the
64 THE HOSPITAL STEWARD'S MANUAL.
night, inspect the fires and lights, and see that
the several night nurses are attending to their
duties.
The night nurses go on duty at tattoo, and
are relieved at reveille. They have the day
to themselves for rest and sleep.
Where there are no special night nurses, the
ordinary attendants of the house take turns
in performing this duty. For this purpose a
roster should be made out by the steward, and
each detailed in his turn, with a corresponding
period of rest to follow his tour of duty.
Besides the nurses proper, certain attend-
ants may be detailed, at the discretion of the
surgeon, for duty in the office, as clerks, &c,
as assistants in the dispensary, as assistants
to the ward-master, and for such other duties
as are not otherwise provided for. Each of
these attendants has his special duties speci-
fically assigned him by the surgeon, to whom,
as well as to the steward or ward-master
under whose orders he may be placed, he is
responsible for their proper performance.
A list should be kept in the office of all
the attendants in the house, with the duties
assigned to each, which may be made out in
the following form : —
THE HOSPITAL STEWARDS MANUAL.
65
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From this list a memorandum of hospital at-
tendants maybe made up, which should be hung
in a conspicuous place in the office, and should
be corrected whenever any changes are made.
Names.
Stewards'.
In office.
In dispensary.
In kitchen.
In knapsack-room.
Ward 1.
Ward 2.
Ward 3.
&c.
&c.
&c
THE HOSPITAL STEWARD'S MANUAL. 67
SECTION V. DUTIES OF COOKS AND LAUNDRESSES.
The duties of cooks and laundresses will be
described in full in the articles on the kitchen
and laundry, (q. v.)
SECTION VI. — DUTIES OF HOSPITAL ATTENDANTS IN
BATTLE.
The duties of the hospital attendants in
battle are of the highest importance, and on
their faithful execution the successful succor-
ing of the wounded must in a great measure
depend. The surgeon must, therefore, exact
the strictest discipline during an engagement,
and the slightest disobedience of orders or
neglect of duty must be punished in an ex-
emplary manner.
The attendants may be divided into two
classes : those who remain at the depots esta-
blished at the rear of the line of battle, and
those who go upon the field.
Those who remain at the depots are selected
for this purpose by the surgeon in charge of
the depot.
One or more experienced stewards, one or
more cooks, and a sufficient number of nurses
68 THE HOSPITAL STEWARD'S MANUAL.
will be detailed for this purpose. The number
of attendants needed will vary with the num-
ber of surgeons assigned to the depot for duty,
and the probable number of wounded: it is
in every case determined by the surgeon in
charge of the depot.
The depot established, the hospital steward
at once proceeds to open such panniers and
chests as may be necessary to get out a suffi
cient number of bandages, dressings, stimu-
lants, and opiates, or other articles required by
the surgeons.
If the depot is near the scene of actual
conflict, no more should be laid out than is
absolutely necessary for actual use, in order
that, if it becomes advisable to change the
location of the depot, it may be effected with
as little loss of time as possible.
Instrument-cases should be laid out and
unlocked, but instruments should not be laid
out, except by the surgeon, as they are needed
for particular operations; and, for the same
reasons, so soon as the surgeon is done with
any instrument, it should be at once carefully
cleaned and replaced in the case.
A house, barn, or other building, is gene-
rally selected as a depot, if it is practicable to
THE HOSPITAL STEWARD'S MANUAL. 69
do so. When this is the case, the attendants
should at once be set to work by the steward
in cleaning and preparing it for the reception
of the wounded. The cooks, meanwhile,
should make a fire, and prepare tea and soup
for their refreshment.
Water is to be brought, both for drinking pur-
poses and for the surgeons' use. Sponges are
to be soaked, and every necessary preparation
made.
When the wounded begin to arrive, some
of the attendants assist in removing them from
the ambulances and carrying them to the
places assigned by the surgeon; while others
wait on the surgeons during the operations
and dressings, and render such assistance as
may be required of them.
At the principal depots in the rear, the
same preparations are made, but on a larger
scale. In every case, the special arrangements
are ordered by the medical officers, and the
assignments of the several duties to the assist-
ants are made by the same authority.
The hospital attendants who go upon the
field may be divided into two classes: those
who accompany the medical officers, who go
upon the field for the immediate succor of the
70 THE HOSPITAL STEWARD'S MANUAL.
wounded, and those who accompany the am-
bulances and litters to help the wounded into
them, or bear the hand-stretchers.
Each medical officer should be accompanied
upon the field by an orderly, who carries the
hospital knapsack, in which is placed a supply
of instruments, dressings, &c. for immediate
use. When the surgeon stops to give his
services to a wounded man, the orderly at
once unslings his knapsack and prepares to
hand out to the surgeon the articles needed in
dressing the patient.
The medical officer should also be accom-
panied by two intelligent attendants, one of
them a hospital steward where possible, to
assist him in any operation he may perforin
upon the field.
The ambulances are to be accompanied by a
sufficient number of attendants, with hand-
stretchers, to pick up the wounded and carry
them from positions inaccessible to the ambu-
lances, or where it is not advisable that these
should go, to the nearest ambulances, or field
depot.
In lifting the wounded and placing them
upon the stretchers, the greatest tenderness
should be used, especially where there is reason
THE HOSPITAL STEWARD'S MANUAL. 71
to believe that bones are fractured. The
stretchers are each to be carried by two stout
men, who are to take pains to walk so that,
while the foremost steps off with his right foot,
the other may step off with his left, as by
so doing the patient is less likely to be jolted,
and the stretcher is tilted less, than where this
precaution is neglected. When the patient is
to be placed in the ambulance, the attendants
carefully place the litter upon the ground, in
the rear of the ambulance, draw out the am-
bulance-litter on which he is to lie, place it by
the side of the stretcher, gently transfer him
to it, and carefully raise it from the ground
and slide it back into its place in the vehicle.
At least three men are necessary for this pur-
pose, one on each side of the end of the litter
first introduced into the ambulance, and one
at the other end. Care should be taken not
to tilt the litter, or jar it unnecessarily in
getting it into place, and, after having placed
it, to secure it so that it cannot slip out in the
movements of the vehicle.
The ambulance-driver should keep his
horses perfectly quiet while patients are being
introduced, and should move carefully, so as
72 THE HOSPITAL STEWARD'S MANUAL.
to avoid jolting as much as possible while
going to the depot.
Arrived at the depot, the ambulance is to
be backed up as near the entrance as possible,
the litters, with the patients upon them, are to
be drawn out one by one, and carried to the
place assigned them, the patients removed,
the litters replaced, and the ambulance starts
off once more for a fresh load.
The number of hospital attendants allowed
in the field being usually found insufficient
for this purpose, an additional detail is gene-
rally required. The musicians are usually
selected; but, in addition to these, an adequate
number of temporary assistants will generally
be furnished by the commanding officer, at the
request of the surgeon.
The principle endeavored to be established
is that the number of men actually on that
duty should be sufficiently large to give all
reasonable assistance during the engagement,
in order that there may be no excuse for
soldiers to leave the ranks under the pre-
tence that they are needed to assist the
wounded.
Hospital attendants and soldiers specially
detailed to the ambulance corps during an
THE HOSPITAL STEWARD'S MANUAL. 73
engagement should remember that their duty
is strictly a military one, and that there is no
more excuse for cowardice or for disobedience
of orders in their case than there is in that of
any other soldiers on duty on the field of
battle.
PART II.
DISCIPLINE, POLICE, AND GENERAL SUPER-
VISION OF MILITARY HOSPITALS.
CHAPTER I.
The General Discipline in the Hospital.
A military hospital requires administration
according to the strictest military discipline.
Nothing short of this will secure efficiency.
The surgeon holds the chief steward respon-
sible for the condition of every part of the
institution under his charge. The steward, on
the other hand, holds his several subordinates
responsible for the due performance of their
duties. The details of these various duties are
found throughout this work: here, therefore, we
limit ourselves to certain general regulations
which will be found necessary to maintain order.
SECTION I. OF THE ROLL-CALLS.
A roll-call of all the stewards, ward-masters,
nurses, cooks, and other attendants or extra-
duty men, should be held at least twice daily,
— at reveille and tattoo. A noon roll-call is also
desirable. The stewards should be called first,
where practicable; the nurses in charge of
7* 77
78 THE HOSPITAL STEWARD'S MANUAL.
wards should be called next. Each, as he
answers to his name, should report whether all
the patients under his care are present or not,
— a fact which he must ascertain, by actual
inspection, before leaving the ward to go to
roll-call. These roll-calls are of great import-
ance in large hospitals : they should, therefore,
be strictly regarded as a military duty, and all
attendants not present should be punished as
absent without leave, unless excused on account
of special duty.
SECTION II. DAILY ORDER OF HOSPITAL DUTIES.
The following schedule will be found con-
venient for the business of the hospital : —
1. Reveille, at 6 J a.m. in winter, and 5 a.m.
in summer. Morning roll-call, fifteen minutes
after.
2. Breakfast-call, 7 a.m. in winter, and 6
A.M. in summer.
3. Surgeon's call, 9 a.m. in winter, and 8£
in summer.
4. Dinner, 12 m., preceded by noon roll-call
when so ordered.
5. Surgeon's evening call, 5 p.m.
THE HOSPITAL STEWARDS MANUAL. /9
6. Supper, 6 p.m.
7. Tattoo and evening roll-call, 8 p.m.
8. Taps (lights extinguished), 9 p.m.
These calls should, whenever possible, be
sounded upon a bugle or beaten on a drum,
in order that all patients and attendants may
be informed. The hours for each call will, in
every case, be regulated by the surgeon in
charge.
At reveille, all attendants, and such con-
valescents as are able to do so, will rise,
wash and dress ; after which each convalescent
patient who is able will make his own bed;
the attendants will make theirs, and will
immediately proceed each about his several
duties, such as sweeping the floors, the pass-
ages, &c, cleaning the spittoons, and similar
work.
At hreakfast-call, those convalescents who
are able will go to the dining-hall to break-
fast, together with the attendants, except those
whose duty it is to attend to the distribution
of food to patients confined to bed. This dis-
tribution should be made while the conva-
lescents are absent at their breakfast, — the
preparations having been previously completed,
80 THE HOSPITAL STEWAKD's MANUAL.
so that the distribution may commence imme-
diately after they leave the room.
The convalescent patients should not be
allowed to straggle irregularly through the
house to their breakfast or any of their other
meals.
They should be drawn up in order in each
ward by the chief nurse, who should call the
roll, to see that all those directed by the surgeon
to take their meals at the general table are
there, and no others; after which they should
be marched, by one of the attendants, from the
ward, through the passages, to the dining-hall.
After breakfast they should be marched back
in the same order.
The attendants employed in the distribution
of food to patients in bed should receive their
breakfast immediately after all the patients
have received theirs. The chief nurse of each
ward will see that immediately after breakfast
the ward is put in order for the visit of the
surgeon. No patient should be allowed to
leave his ward after breakfast, except for
necessary purposes, before the surgeon's visit.
At surgeon's call, the several surgeons pro-
ceed at once to visit the wards under their
charge, examining each patient carefully, and
THE HOSPITAL STEWARD'S MANUAL. 81
causing the prescription and diet for each to
be entered in the prescription and diet book.
The prescription and diet book goes to the
steward in charge of the dispensary, who puts
up the medicines, attaching to each bottle,
box, or package a label, on which is written
the number of the ward and bed, the name of
the patient, date of the prescription, with the
directions as to dose, time of taking, &c.
The chief nurse of each ward should keep a
slate, on which he should enter opposite the
name of each patient the diet allowed, with
any specific directions which may be given by
the surgeon in individual instances.
At dinner and supper call, the same general
order is to be followed as was described for
breakfast-call.
At surgeons evening call, the regular second
visits of the surgeon are made to those patients
who require it, in the same manner as in the
morning.
At tattoo, all patients must make their pre-
parations for retiring, and all must be in bed
at nine o'clock, when taps should be sounded
and unnecessary lights extinguished.
82 THE HOSPITAL STEWARD'S MANUAL.
SECTION III. THE STEWARDS VISITS OF INSPEC-
TION.
Besides the visits which he necessarily pays
to different parts of the house in the execu-
tion of his several duties, the chief steward
should pay every part of the hospital a formal
visit twice or three times daily.
The middle of the morning, the middle 'of
the afternoon, and at evening, between taps
and tattoo, are good times for these visits.
To these may be added a visit about half an
hour after taps, to inspect the condition of the
lights and fires.
At these regular visits, the steward should
note the condition of every thing, and espe-
cially the order, the cleanliness, the ventila-
tion, the lighting, and the warming of the
building : the state of the kitchen and dining-
room, of the bath-rooms and the latrines, is
also to be carefully observed. Any negli-
gence or violation of duty must be at once
corrected; and whenever repairs are needed
or gross violations of discipline have occurred,
it should be at once reported to the surgeon
in charge.
THE HOSPITAL STEWARD'S MANUAL. 83
SECTION IV. — OF SUNDAY MORNING INSPECTIONS.
In post hospitals it is usual for the com-
manding officer to complete his Sunday morn-
ing inspection by inspecting the hospital and
its appendages in company with the surgeon.
In general hospitals the Sunday morning in-
spection is usually conducted by the surgeon
in charge. The proper time for such inspec-
tions is between the hours at which the
attending surgeons have completed their visits
and dinner-call, — say between ten and twelve
o'clock. The steward should go through the
hospital immediately before the inspection
commences, and see that all things are pro-
perly prepared.
To prepare for inspection. The hospital
should be neat and clean ; those patients who
are sitting up should be neatly dressed in
uniform, their faces and hands clean, hair
neatly brushed, and shoes well blacked. The
attendants and stewards should appear in full-
dress uniform according to their rank, except
where the inspecting officer may previously
have ordered that undress uniform only need
be employed.
The inspecting officer visits all parts of the
84 THE HOSPITAL STEWARD'S MANUAL.
hospital, the store-rooms, dispensary, kitchen,
knapsack-room, bath-rooms, latrines, &c, as
well as the several wards.
The steward enters each ward before him
and commands attention, on which all patients
who are able to do so, rise and stand in the
position of attention until the inspecting
officer has passed out.
SECTION" V. — ON THE MUSTER OF HOSPITAL ATTEND-
ANTS AND OP SOLDIERS ABSENT FROM THEIR
COMPANIES IN HOSPITAL.
On the last day of the months of February,
April, June, August, October, and December,
the enlisted hospital attendants and soldiers,
both sick and on duty, are mustered for their
pay. In the field, and at post hospitals, the
mustering officer who musters the troops or
garrison to which the hospital is attached per-
forms this duty. In general hospitals it is
usually performed by the surgeon in charge.
The muster roll having been previously pre-
pared under the supervision of the steward, the
attendants, and the patients who are able to do
so, are duly assembled on muster day, and the
roll called in the presence of the mustering
THE HOSPITAL STEWARD'S MANUAL. 85
officer, a mark being put before the name of
each individual present. Subsequently the seve-
ral wards are visited seriatim, and the muster
roll completed by checking upon the roll the
names of the patients in bed in each.
The form of the muster roll, with the direc-
tions for making it out, are given on pp. 86,
87, following.
86 THE HOSPITAL STEWARD'S MANUAL.
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NOTES.
1. Under the head of "Remarks," the date of any soldier's
joining, whether originally, or from any absence; all changes of
rank, by promotion, appointment, or reduction, with date of same,
and No., date, &c, of order; all authorized stoppages, fines, sen-
tences, with No., date, &c, of order, &c. : in case of absence, the
nature and commencement of, No., date, &c, of order, and period
assigned for same (to be repeated on every roll while it lasts) ; if
wounded in battle, or injured on duty, — if sick or confined, a remark
to that effect, &c. &c, — must be carefully stated opposite to the
name of the person concerned, xoith every thing else necessary, either
to account fully for every individual, — to guide the paymaster, — or
insure justice to the soldier and to the United States.
2. In noting stoppages to be made for loss or damage to public
property, the gross amount due for Ordnance, Horse Equipments,
Clothing, &c, will be separately stated in the order enumerated in
par. 1187, G. R.
3. Additional pay, due under Sec. 2, Act of Aug. 4, 1854, will
be thus noted, — viz. : " For 1st re-enlist. $2pr. mo. ;" or, "For 2d
re-enlist. $3 pr. mo. f or, "For 3d re- enlist. $4 pr. mo.," &c, &c.
That due under Sec. 3 of the same act, thus : " For cert, of merit, $2
pr. mo." That due under Sec. 4 of the same act, thus : "In lieu of
comm. $2 pr. mo."
4. The instalments of Bounty due, under Sec. 3, Act of June 17,
1850, are paid as follows : -J^, |, ^, \, at the end of the 1st, 2d,
3d, and 4th years, respectively, the remainder at the expiration
of enlistment; and will, under the head of "Remarks," be noted
thus: "Eet'd Bounty due, 1st (or 2d, 3d, #c.) insl. $ ." See
G. 0. 20 of 1850. Besides which, in the columns headed "Bounty
Paid" and "Bounty Due," must be entered, in figures, the whoh
amount hitherto paid, and the whole amount yet due, on account of
said bounty.
5. The "three months' extra pay," for re-enlistment, under
Sec. 29, Act of July 5, 1838, being paid by the recruiting officer,
should not be noted on the muster rolls.
6. The roll of those belonging to the hospital will be immediately
THE HOSPITAL STEWARD'S MANUAL. 89
followed by that of those who, since last muster, have ceased to
belong to it. These will be classed in the following order, — viz. :
Discharged, Transferred, Died, Deserted; and the utmost particu-
larity will be observed in the remarks concerning them. Date and
place will, in every case, be given ; and No., date, &c, of orders, or
description of authority, be always carefully specified. Soldiers
discharged and re-enlisted, or who have deserted and been retaken,
since last muster, have their place in both of the above rolls.
7. The remark "discharge and final statements given" will be
made opposite to the name of every discharged soldier to whom
such papers have actually been given. But the blank spaces under
the head of "Last Paid" are to be tilled as usual.
8. In all cases of "re-enlistment" prior to the expiration of the
term of service, the discharge on the old enlistment will be given
at the time the soldier "re-enlists," — from and on which day his
pay on the new enlistment will commence.
9. Within three days after each regular muster, the mustering
officer or commandant of the post will transmit to the Adjutant-
General a copy of the muster roll of each company. Blanks will
be supplied from the Adjutant-General's office, and will be
acknowledged on the first muster roll forwarded after their
receipt.
90 THE HOSPITAL STEWARD'S MANUAL.
The roll has appended to it this recapitu-
lation : —
RECAPITULATION.
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THE HOSPITAL STEWARD'S MANUAL. 91
The whole is certified to in the following
form : —
I certify, on" honor, that this Muster Roll
is made out in the manner required by the
printed notes ; that it exhibits the true state
of the Hospital Department for the period
herein mentioned 5 that the "Remarks" set
opposite each name are accurate and just; and
that the "Recapitulation" exhibits in every
particular the true state of the hospital, as re-
quired by the Regulations and the Rules and
Articles of War.
Surgeon in charge of Hospital.
Station :
Date :
I certify, on honor, that I have carefully
examined this Muster Roll ; that I have mus-
tered and minutely inspected the hospital at-
tendants; and that the police and general
condition of the Hospital Department is found
to be as follows :
Inspector and Mustering Officer.
92 THE HOSPITAL STEWARD'S MANUAL.
SECTION VI. — OF THE GUARD.
In camps and post hospitals the guard is
furnished from the troops for whose benefit the
hospital is established ; it is under the orders
of the officer of the day, and need not, there-
fore, be made the subject of remark in this
place.
In detached general hospitals only, however,
the guard, consisting of one or more non-com-
missioned officers, and a sufficient number of
privates, according to the number of posts, is
furnished to the hospital on the application of
the surgeon to the commanding officer, with
orders to report to the surgeon under whose
command they remain.
The number of posts is determined by the
surgeon. There should always be a sentinel
posted at each entrance to the hospital, with
orders to allow no patients or attendants to
leave the building, except when furnished with
a written pass, signed by the surgeon. Orders
should also be given to admit no one, except
patients or attendants returning from pass ; new
patients arriving with proper orders for admis-
sion ; persons known to have business in the
THE HOSPITAL SETWARD'S MANUAL. 93
hospital ; the medical officers and those wish-
ing to see them ; and visitors on the visiting
days and hours only.
Besides these, sentinels may be placed on
such other posts as in the opinion of the sur-
geon may be necessary.
The guard should live in the hospital, or in
tents erected near it, as is most convenient in
the opinion of the surgeon.
They are taken up on the hospital provision
return, and obtain their meals at the general
table for the convalescents and attendants.
SECTION VII. OF THE GUARD-HOUSE.
In all general hospitals of any size, there
should be a place set aside for the confinement
of those guilty of drunkenness, disobedience to
orders, or other military offences.
Where possible, this should be in a separate
building, and is then called the guard-house ;
a sentinel should be posted before the door.
Where this is not possible, a room should be
employed for the purpose, and is known as the
guard-room.
No patients or attendants should be con-
fined except on order of the medical officers,
94 THE HOSPITAL STEWARD'S MANUAL.
or by the steward, who will immediately report
the case to the surgeon in charge : all other at-
tendants must report delinquents to the sur-
geon, or steward, for punishment, and not
confine them themselves.
In these punishments the surgeon is, of
course, guided by the same laws and regula-
tions as apply in other cases to the punish-
ment of the offences of enlisted men by com-
manding officers.
SECTION VIII. RULES AND REGULATIONS FOR THE
GOVERNMENT OF MILITARY HOSPITALS.
In every hospital, a code of rules and regu-
lations should be drawn up by the surgeon in
charge, printed upon large cards, and affixed
to the walls in each ward, and in other con-
spicuous places. The following is an illustra-
tion of the form which may be employed. It
should receive such modifications as local causes
may make necessary to adapt it to any given
hospital.
THE HOSPITAL STEWARD'S MANUAL. 95
Rules and Regulations for the Government of
the United States Army General Hospital at
1. No patient will be allowed to leave the
hospital without permission from the surgeon
in charge. The same rule will hold with
respect to nurses and other attendants.
2. No pass will be issued except between
the hours of 10 A. m. and 12 m., except in
urgent cases. The pass will be shown to the
sentinel on post, and retained by the person
receiving it until his return, when it will be
given to the sentinel.
3. No smoking, swearing, or loud talking
will be permitted in the wards and passages
of this hospital ; and spitting on the floor, or
defacing the building in any way, is positively
forbidden.
4. The beds will be made every morning by
the attendants, or oftener, if necessary. Pa-
tients able to do so will, however, make their
own beds.
5. No patient will occupy his bed without
undressing.
6. Every patient, who is able, will wash his
face and hands at least every morning, and
96 THE HOSPITAL STEWARD'S MANUAL.
keep the rest of his body in a cleanly condition.
Those who are unable to do this will have it
done for them by the attendants. Every pa-
tient whose condition does not forbid it will
take a bath on his admission into the hospital.
7. During the morning visit of the medical
officer, every patient and nurse must be in
the ward ; nor will the former leave it before
his visit. Patients who are able, will rise
when the medical officer enters the ward, and
remain standing at the sides of their beds
until prescribed for or otherwise ordered.
8. No loud noises or improper language will
be allowed in the wards at any time. All
talking will cease at Si p.m., when all pa-
tients and nurses, except those of the latter
on duty, will go to bed.
9. All lights in the hospital, except those in
the offices and surgery, will be lowered at 9
p.m. All other lights will be extinguished
at taps, unless otherwise directed by the at-
tending medical officer.
10. No patients or nurses will be allowed to
enter the office, surgery, or kitchen, unless on
business connected with their duties. Loung-
ing about the halls is also forbidden.
11. No persons will be allowed to enter the
THE HOSPITAL STEWARD'S MANUAL. 97
hospital without special permission from the
surgeon in charge, or the medical officer of the
day.
12. No provisions or spirituous liquors of
any kind shall be brought within the hospital
without permission of the medical officer of
the day. Nor will any relatives or friends of
patients be allowed to give such articles to
them, without permission from the medical
officers of the ward.
13. Patients will give prompt obedience to
the steward, ward-master, and nurses, in all
lawful commands. Any infractions of disci-
pline, disobedience of orders, drunkenness, or
disorderly conduct, will be promptly punished.
98 THE HOSPITAL STEWAKD S MANUAL.
CHAPTER II.
Police and General Supervision in Hospitals.
SECTION I. — CLEANLINESS OF THE HOSPITAL.
The hospital, hospital grounds, and all its
appurtenances, must be maintained in a state
of cleanliness as complete as possible.
Cleanliness of the floors is to be obtained
by scrubbing or sweeping.
The whole hospital should be carefully and
completely swept at least once daily, and
as much oftener as dirt or litter accumulating
in particular localities renders it necessary.
The wards are swept by one of the attendants,
the chief nurse being responsible for the pro-
per performance of the duty; the kitchen, by
one of its attendants, the chief cook being
responsible; the dining-room, by one of the
attendants assigned to duty there; and the
halls, passages, stairs, offices, &c, by attend-
ants specially assigned to the duty.
THE HOSPITAL STEWARD'S MANUAL. 99
For the proper performance of this duty
throughout the hospital, the steward must re-
member that he is responsible, and he must
hold subordinates charged with its execution
to a strict accountability.
Sweeping should be effectual, but should be
executed in such a manner as not to fill the
atmosphere with dust.
The broom should not be recklessly used,
but should be carried steadily and gently over
the floor, bearing the dust before it. Where
there is much dust, the floor may be sprinkled
before being swept, or the broom may be
dipped lightly into water. The dirt should
not be swept from wards or other apartments
into the passages, but should be carried away
in dust-pans.
Scrubbing is not so generally available as
sweeping: the objection to it is that it leaves
the floor damp for a considerable time after-
wards. It is, however, to be resorted to when-
ever necessary to effect cleanliness. Sand may
be used to advantage in scrubbing well-made
floors. The reckless use of water is to be
avoided. It soaks through the cracks of the
floor into apartments below, if there are any,
and leaves unnecessary dampness behind.
100 THE HOSPITAL STEWARD'S MANUAL.
Where the condition of the floor is not very
bad, the use of a wet mop may be substituted
for scrubbing, requiring less time for its exe-
cution, and not leaving so much dampness.
Either scrubbing or mopping should, when-
ever possible, be done in clear, dry weather,
(on good drying-days.)
Certain portions of the hospitals require
special attention to preserve their cleanliness.
The kitchen should be swept out after each
meal, or as much oftener as necessary.
The dining-room, after each meal.
The water-closets should be not only swept,
but mopped or scrubbed, daily.
The walks around the hospitals should be
swept daily. No garbage or filth should be
allowed to collect in any place around the
buildings.
Not merely the floors, but the walls, the
ceilings, and the windows of the hospital re-
quire to be kept carefully clean.
The walls should be dusted from time to time,
and kept free from dirt and cobwebs. Writing
upon or otherwise disfiguring the walls or wood-
work must be strictly prohibited. White-wash-
ing must be resorted to whenever necessary
to maintain neatness. The whitewash should
THE HOSPITAL STEWARD'S MANUAL. 101
not merely be composed of lime and water, but
should have salt or glue added to it, to make it
less liable to rub or crack off.
Painted woodwork should be wiped, when-
ever soiled, with a damp cloth, and scrubbed
when necessary.
The windows should be washed whenever
their condition indicates the necessity. Once a
week is, generally, often enough. Here, as with
regard to scrubbing, a caution may be given
against the reckless and excessive use of water.
SECTION II. VENTILATION.
The steward is also responsible to the sur-
geon for the effective condition of the means of
ventilation, whatever these may be.
In the best-constructed hospitals, ridge-venti-
lation, conjoined with ventilators flush with
the floor, is the plan resorted to. The steward
should notice, whenever he enters a ward, that
the floor-ventilators are sufficiently open to
secure a constant change of the air of the apart-
ment. In rainy weather the ventilators on the
windward side of the building should be so par-
tially or completely closed as to prevent rain
from beating in upon the floor of the apartment.
9*
102 THE HOSPITAL STEWARD'S MANUAL.
Where other means of ventilation are re-
sorted to, attention is to be paid to their
construction ; and if the steward does not under-
stand the principle upon which they act, he
should apply to the surgeon for such explana-
tions as will enable him intelligently to under-
take their regulation.
In hotels, private houses, and other buildings
temporarily used as hospitals, in which no
means of ventilation excej)t the windows,
doors, and fireplaces exist, special care is neces-
sary. In the summer-time the windows should
be raised at the bottom and let down at the
top. The doors should be kept open. The
fireplaces and chimneys should be free from
obstructions.
In the winter the windows should be let
down at the top, but not so far as to render
the ward too cold.
The cleanliness and ventilation of the wards
should be such that a person entering them
from the open air should not perceive the
slightest close or unpleasant odor. Whenever
the steward, in going his rounds, perceives
such an odor, its cause should be investigated,
and the necessary steps at once taken to
remedy it.
THE HOSPITAL STEWARD'S MANUAL. 103
A few statements may here be made to give
the steward an idea of the amount of ventila-
tion required to obtain the best results.
Each patient in hospital should have allotted
to him from one thousand to fifteen hundred
cubic feet of space. A thousand cubic feet will
be secured by allowing to each bed a floor-
surface six feet wide by twelve long, in an
apartment in which the ceiling is thirteen
and eight-ninths feet high.
Twelve hundred cubic feet will be secured
by allowing each bed a floor-surface of seven
feet by twelve in an apartment fourteen and
two-sevenths feet high.
Thus, in a ward twenty-four feet wide and
of either of the above heights, there may be
two rows of beds, one on each side of the ward,
the beds separated from each other by at least
three or four feet. Where the ceilings are
lower, a greater floor-surface should be allowed
to each bed.
The number of beds in each ward is, there-
fore, of serious importance. It should be in
every case determined by the surgeon, and,
once having been established, should not be
deviated from except by his express orders.
It is, however, of no avail to obtain for the
104 THE HOSPITAL STEWARD'S MANUAL.
patient sufficient cubic space unless the venti-
lation is such as to obtain the requisite change
of air. It has been calculated that each patient
takes into his lungs, and throws out contami-
nated and unfit to be breathed again, from
three to four hundred cubic feet per hour. If
to this large element of contamination be added
the deterioration of the atmosphere of the ward,
resultiug from the cutaneous exhalations of the
sick, and the effluvia from suppurating wounds,
offensive discharges, &c, it will be seen at a
glance that the air of a hospital-ward must
become rapidly unfit for use. The great object
of ventilation is to produce such a steady and
constant change of air as will cause the con-
tinual renewal of the contaminated ward-
atmosphere by fresh supplies from without. It
has been estimated that for this purpose each
patient requires a supply of fresh air at the
rate of at least double the cubic space above
mentioned, or from two to three thousand cubic
feet, per hour.
These conditions cannot be neglected or over-
looked without inevitable injury to the sick,
manifested in the type of disease, as well as
by slowness of recovery and increase of mor-
tality.
THE HOSPITAL STEWARD'S MANUAL. 105
In certain cases the use of disinfectants will
be needed in addition to careful cleanliness
and ventilation, — especially in wards contain-
ing patients with malignant fevers or with
suppurating wounds. In all such cases, how-
ever, the use of disinfectants should be ordered
by the surgeon, and not resorted to by the
steward or other nurses upon their own re-
sponsibility.
Hospital tents should be ventilated by rip-
ping one or more seams near the ridge-pole of
the tent, the rips to be about eighteen inches
long : the gap may be propped open by a
notched stick. Rain is prevented from enter-
ing by the tent fly.
This precaution should always be taken in
hospital tents which are full of patients ; but
it is especially necessary when the tent is
heated in the winter-time, either by a stove 01
the trenched fireplace described in the next
section.
SECTION III. — THE WARMING OF THE HOSPITAL.
The steward is responsible, during the colder
portion of the year, for the proper management
of the means employed to warm the hospital.
In order that this may be satisfactorily and
106 THE HOSPITAL STEWARD'S MANUAL.
efficiently done, a thermometer should hang in
every ward. The proper temperature should
be indicated by the surgeon. About 70° to
72° Fahrenheit is that usually ordered.
This temperature may be obtained in well-
organized general hospitals by properly con-
structed furnaces, or by a steam heating-appa-
ratus. In the great majority of the general
hospitals at present organized in the United
States, however, it is effected by stoves.
The more complicated and complete means
of warming will, therefore, be passed by in the
present work, with the remark that, if they
be adopted in any general hospital, they
should be so regulated as to keep the wards
steadily at the required temperature, neither
being, on fhe one hand, so managed as to have
them at times unnecessarily warm, nor, on
the other, so neglected as to allow them to
cool more than at the most a very few de-
grees below the standard.
Stoves used for warming hospitals may be
made for burning either wood or coal. The
latter are preferable where coal can conve-
niently be obtained.
The chief nurse of each ward is responsible
to the steward for the due maintenance of the
THE HOSPITAL STEWARD'S MANUAL. 107
fires and the temperature of the wards. Fuel
is carried from the place in which it is stored,
by one or more of the attendants, under the
order of the chief nurse.
Care must be taken to keep the stoves neat
and well blacked, to avoid dropping fragments
of fuel upon the floor about the stoves, and to
remove the ashes from time to time, as it be-
comes necessary, making always as little dust
as possible.
To counteract the unnatural dryness of the
atmosphere produced by the use of stoves, a
vessel of water should be set on the top of
each.
The stoves in the wards should on no ac-
count be used for cooking.
Hospital tents may also be warmed by stoves.
It is perhaps preferable to warm them in the
following manner : —
A trench is dug through the middle of the
tent, about eighteen inches deep, and twelve to
sixteen wide. This trench should extend about
four feet beyond the tent at either extremity.
The trench is covered over with pieces of sheet-
iron, supported by iron cross-bars, the iron for
this purpose to be obtained from the quarter-
master on special requisition by the surgeon.
108 THE HOSPITAL STEWARD'S MANUAL.
A chimney is built of sods or mud at the high-
est extremity of the tent; a pit about two and
a half feet deep and three long by two wide is
sunk at the other for a fireplace. A wood
fire being now built in this pit, the draft car-
ries the flame and smoke along the trench be-
neath the hospital tent, which is thus not only
warmed, but the ground on which it stands is
thoroughly dried.
The fire will serve also to cook for the hos-
pital.
Care must be taken not to overheat the tent,
which is likely to happen when this method is
used, unless ventilation at the top of the tent
is resorted to, as described in the last section.
SECTION IV. LIGHTING THE HOSPITAL.
Hospitals may be illuminated by candles, by
lamps, or by gas.
Gas is beyond question the most satisfactory
method of illumination. As usually employed,
it is also the most expensive. This is to a
great extent the result of unnecessary extrava-
gance ; and the gas-lights should therefore be
carefully supervised by the stewards. No
more gas-jets should be illuminated than are
THE HOSPITAL STEWARD'S MANUAL. 109
absolutely necessary for the business of the
house, and these should have no more gas
turned on than is necessary. At nine o'clock
all the burners should be extinguished except
a single one in each ward, which should be so
regulated as to give but a feeble flame, like
that of a candle, and a few in the passages and
on the staircases, to enable attendants on duty
to go about the buildings. The gas-bill is
paid out of the hospital fund.
Lamps suspended from the ceiling, or fixed
upon the wall at convenient places, are, next
to gas, the most desirable means of illumina-
tion. Camphene or burning-fluid lamps should
be avoided as dangerous, and whale-oil, lard-
oil, or coal-oil lamps preferred. Coal oil has
recently been extensively used for illuminating
purposes, and furnishes perhaps the cheapest
and most satisfactory illuminating fluid. The
oil is paid for out of the hospital fund.
Where lamps are used, they should be
cleaned, trimmed, and filled daily. This may
be done by the attendants in the ward ; but
in a hospital of any size it is much better
to detail one or more attendants, whose special
duty it shall be to collect daily all the lamps
of the hospital, clean, trim, and fill them, and
10
110 THE HOSPITAL STEWARD'S MANUAL.
to return them to their places, for the due exe-
cution of which duties they are responsible to
the steward.
Where neither gas nor lamps can conve-
niently he obtained, it, becomes necessary to
use candles. Candles for this purpose are
drawn from the commissary on the hospital
provision return. Adamantine candles are to
be preferred for general use ; but a small stock
of sperm candles should be kept on hand for
special purposes, as, for instance, the occasion
of any surgical operations necessarily per-
formed at night.
SECTION V. THE LATRINES.
The latrines require careful attention, and
their supervision is an important part of the
duties of the hospital steward.
In every general hospital there should be
well-constructed water-closets attached to each
ward. These should be kept scrupulously dry
and clean, the urinals and seats free from filth,
and the apparatus at all times in good work-
ing order. Any defects or breakage should be
at once reported to the surgeon. The water-
closet should at all times be free from any
offensive smell.
THE HOSPITAL STEWARD'S MANUAL. Ill
It will be found advisable in large institu-
tions to keep an attendant constantly on guard
before the entrance of each water-closet, whose
duty it shall be to inspect its condition after
every patient, in order that all neglects of
propriety or cleanliness may be fixed at once
upon the guilty party.
In temporary hospitals it is not always pos-
sible to secure such costly accommodations:
a very good substitute may then be made,
as follows : a small frame building is con-
structed outside of the hospital building; in
this is placed a trough twelve to twenty feet
long, lined with zinc and covered with a mov-
able lid, in which from four to ten oval holes
are cut.
One end of the trough should be higher than
the other. At the higher end is a faucet to
let in water; at the lower, a pipe, six to
eight inches in diameter, which should run
obliquely to a deep sink dug down to the
gravel, and carefully covered. Lime or some
other disinfectant should be thrown into this
sink at least once a week, and when it is filled
to within six feet of the surface it should be
abandoned, filled in with earth, mixed with
lime, and a new sink constructed. Such sinks
112 THE HOSPITAL STEWARD'S MANUAL.
should never be dug in the neighborhood of
wells.
In camp hospitals even this simple arrange-
ment is not practicable, and ordinary camp
sinks must be used. These should be dug at
some distance from the hospital tents. They
should be each about ten feet long, two feet
wide, and six deep. A crotched stick is driven
into the ground at each end, and a pole laid
across to serve as a seat. Every day a little
earth is thrown in to cover the ordure of the
day previous, and when filled to within two
feet of the surface the sink should be aban-
doned, filled up with lime and earth, and a
new sink constructed.
Where possible, a small shed should be
erected over each sink, to protect patients
during inclement weather. Where lumber can-
not be obtained for this purpose, a screen of
boughs should be erected, to protect the spot
from observation.
SECTION VI. OF THE BATHS AND LAVATORIES.
Wherever possible, general hospitals, even
when only intended for temporary use, should
be furnished with a bath-room ; and in per-
the nosriTAL steward's manual. 113
manent institutions a bath-room should be
attached to each ward. It should be supplied,
wherever possible, with both hot and cold
water. Cast-iron tubs answer an excellent
purpose, and are readily kept in order, particu-
larly if from time to time they receive a coat
of paint.
The bath-room must be kept cleanly and
free from all unnecessary slops, the bath-
tubs neat and free from dirt of any kind.
Patients should not be allowed to use the bath
indiscriminately; the surgeon should indicate
those who may use the ordinary cold bath,
those who need the tepid bath, and those who
should have the hot bath, and the frequency
with which baths may be permitted.
For the great majority of patients, espe-
cially in cold weather, the bath should be
tepid, the temperature being about 80° Fahren-
heit. Where a warm bath is given, the greatest
care should be taken to avoid unnecessary ex-
posure of the patient to cold on leaving the
bath. The bath-room should, if possible, be
well warmed, the doors and windows closed
to avoid drafts. When the patient leaves the
bath, he should be wrapped at once in a warm
blanket and put to bed. Water should not be
10*
114 THE HOSPITAL STEWARD'S MANUAL.
allowed to stand in the bath-tubs after it has
been used for a bath. It should be im-
mediately emptied and the tub rinsed out, to
prevent the sediment deposited from adhering
to the bottom of the tub and rendering it per-
manently unclean.
The Lavatories are intended for convalescent
patients and attendants to wash their hands
and faces on rising in the morning, or at
other times, when necessary to preserve clean-
liness.
They should be in a separate apartment
from the bath-room, whenever practicable.
Where the hospital is not fitted up with a
complete lavatory, specially designed for the
purpose, a room should be prepared, with a
long table or shelf, on which tin basins, with
soap, towels, &c, may be placed for this pur-
pose*. Convalescents able to go to the dining-
room for meals should be obliged to wash their
hands and faces, and comb their hair, daily,
before going to breakfast.
The same cleanliness so necessary every-
where in a hospital should be manifest in the
lavatory. After the morning washing, the
basins should be rinsed and dried, the shelf
cleaned, the soap put into a vessel or vessels
THE HOSPITAL STEWARD'S MANUAL. 115
designed for its reception, and the shelf and
floor carefully dried.
Patients unable to leave their beds should
have their hands and faces washed daily by
the nurses. General sponging of the surface
and washing of the feet should be practised
often enough to maintain cleanliness.
SECTION VII. THE WARDS OF THE HOSPITAL, THEIR
ARRANGEMENT AND ADMINISTRATION.
Hospital wards are of various sizes, and may
accommodate from a very few to a great
number of patients. From twenty to fifty is
probably the most convenient number. The
number of patients in any given ward is to be
determined by the surgeon; and it is the duty
of the steward to place in the ward the num-
ber of beds thus directed. The surgeon will
base his allotment of beds upon an actual
measurement of the apartment, allowing from
one thousand to fifteen hundred cubic feet of
space per bed wherever practicable.
The bedsteads, which are usually of iron in
United States military hospitals, should not in
any case be less than three feet apart, even
when the height of the apartment gives
116 THE HOSPITAL STEWARD'S MANUAL.
the necessary cubic space if they are closer
together.
The bed-furniture consists of a mattress or
bedsack, sheets, blankets, a coverlet, pillow,
and pillow-case.
The best mattresses are undoubtedly those
stuffed with hair. They are the most com-
fortable, the most durable, and are less liable
to become impregnated with unhealthy ex-
halations proceeding from the patients, and
thus to give rise to disease in those subse-
quently occupying them, than any others.
Their great comparative expense, however,
prevents their adoption in such extensive
establishments as those created by the exist-
ing war; and they are not, therefore, generally
met with.
Where, however, they have been furnished,
special care should be used for their preserva-
tion, oiled silk or oil-cloth or gutta-percha cloth
being introduced between the sheet and the
mattress in all cases in which the discharge
from wounds, or the probability of hemorrhage,
or any other cause, renders them liable to be
soiled.
The mattress usually furnished by the
medical purveyor consists of a ticking stuffed
THE HOSPITAL STEWARD'S MANUAL. 117
with corn-shucks either alone or mixed with
straw. This is much less durable than the
hair mattress. It is also much less expensive,
and answers usually a very good purpose.
When it is soiled, or after it has been used
by a patient laboring under typhoid or typhus
fever, it should not be burned, as is frequently
done, but, the contents having been emptied
and destroyed, the tick, if its condition is good,
should be retained, washed and boiled, and
subsequently used as a bedsack.
Bedsacks are probably quite as useful as the
mattresses last described. They are certainly
less expensive. They should be filled with
clean straw, carefully introduced, so as to
break up the stems as little as possible. The
great advantage of bedsacks over any kind
of mattresses is that they may be frequently
emptied, the sack washed and its contents
renewed. This, on the other hand, implies
continual attention and considerable labor;
and there can be no doubt that neglected bed-
sacks form as uncomfortable and unwholesome
a couch as could possibly be furnished a sick
man.
Where bedsacks are used, the straw should
be renewed at least once a month for conva-
118 THE HOSPITAL STEWARD'S MANUAL.
lescents, attendants, and ordinary cases, and
as much oftener for fever-cases, suppurating
wounds, &c, as the nature of the case may
require.
When the bedsack is emptied, it should
never be filled again until it is washed and
boiled.
"In barracks, twelve pounds of straw for
bedding will be allowed to each man, servant,
and company woman.
" The allowance and change of straw for
the sick is regulated by the surgeon."*
Straw for this purpose is obtained from the
quartermaster on a requisition signed by the
surgeon.
Two sheets are allowed to each bed. For
convalescents and attendants it will be suffi-
cient if the lower sheet is removed each week
and is replaced by the upper, which is to be
replaced by a clean one. But for fever-cases,
or where there are offensive discharges, the
sheets should be changed as often as they are
soiled or as the change is directed by the
surgeon.
Each bed should be furnished with one
* Revised Reg., Art. XLII. l\ 1126-1127
THE HOSPITAL STEWARD'S MANUAL. 119
blanket in summer-time and two in winter, or
with such additional ones as may be directed
by the surgeon in special cases. The blankets
should be changed and washed as often as
they become soiled.
Each bed is furnished with a coverlet,
which is usually of a woven white material.
It should be changed whenever it becomes
soiled.
To keep the white coverlet clean, patients
should never be allowed to lie down on the
bed with their clothes on.
One pillow is allowed to each bed, except
in special cases, where additional ones are
ordered by the attending surgeon. The pillow-
case should be changed once a week, or as
often as it is soiled.
The beds of all patients who are able to go
to their meals in the mess-halls should be
made up by themselves immediately after
reveille. Those of patients unable to leave
their beds should be made up from time to
time, as the nature of the case may permit.
Each bed should have attached to it or sus-
pended above it a ticket, on which is recorded
the name, rank, regiment and company, dis-
ease, and date of admission of the patient, and
120 THE HOSPITAL STEWARD'S MANUAL.
on the reverse of which is a list of his personal
effects. For the form of this ticket, see Part II.
chap. iii. sect. 1.
Mosquito-nets should, so far as practicable,
be furnished to every bed in those seasons
and localities in which they are desirable.
They should be kept carefully clean and in
good repair.
The ward should also be furnished with a
number of small tables or stands, upon which
may be placed the medicines, &c. of the
patients. One to every two beds is usually a
sufficient number. Each serves, therefore, for
two patients. These tables should be kept
scrupulously clean, and nothing should be
allowed upon them except such articles as are
actually in use.
Chairs to the number of one to every bed,
or at least one to every two beds, are generally
supplied. These and the tables should have
definite places assigned them, out of which
they should never be found except when
actually in use.
The spittoons, chamber-pots, and chamber-
chairs should likewise be the subject of care-
ful supervision. Spittoons should be emptied
and washed out thoroughly every day; cham-
THE HOSPITAL STEWARD'S MANUAL. 121
ber-pots, bed-pans, urinals, and the receptacle
of chamber-chairs, every time they are used.
In hospitals in which water-closets are not
attached to each ward, every ward should
have a small room partitioned off, into which
patients may go to use the chamber chairs or
pots, whenever practicable, in order that the
odor which accompanies the evacuations may
not be diffused throughout the ward.
The floor of the ward should be constantly
kept clean and neat, no litter or dirt being for
a moment allowed upon it; nor should pa-
tients' clothes be suffered beneath the beds.
Each ward has allowed to it a certain num-
ber of attendants, which varies with the num-
ber of patients, one to every ten patients being
the allowance of army regulations.*
The duties of these attendants are detailed
in Part I. chap. iii. sect. 4.
SECTION VIII. THE OFFICE OF THE HOSPITAL.
An apartment convenient to the entrance
of the hospital is set aside as the office, in
which the records and papers of the institution
are kept, and where general business-matters
* Revised Reg., Art. XLIX. § 1258.
11
122 THE HOSPITAL STEWARD'S MANUAL.
connected with the establishment are trans-
acted.
The regulations direct that "the senior
medical officer of each hospital, post, regiment,
or detachment will keep the following records,
and deliver them to his successor. A register
of patients; a prescription book; a diet book;
a case book; a meteorological register; copies
of his requisitions, annual returns, and quar-
terly reports of sick and wounded; and an
order and letter book, in which will be tran-
scribed all orders and letters relating to his
duties.
"He will make up the muster and pay rolls
of the medical cadets, hospital steward, female
nurses, and matrons, and of all soldiers in
hospital, sick or on duty, detached from their
companies, on the forms furnished from the
Adjutant-General's office, and according to the
directions expressed on them. He will make
the rolls of the cooks and nurses for extra-duty
pay, which will be paid by the paymaster, in
the absence of a medical disbursing officer, as
in other cases of expenditures for the medical
department."*
* Revised Reg., Art. XLIV. \\ 1254-1256.
THE HOSPITAL STEWARD'S MANUAL. 123
Practically, a large part of these records are
kept either by one of the stewards, or by one
or more attendants selected by the surgeon
for the purpose, and who are, in fact, the clerks
of the hospital, — an office which is not formally
recognized by law or regulations.
A few remarks may be made on each of
these heads.
The Register of Patients.
This record should be kept in a book pro-
perly ruled for the purpose in accordance
with the form prescribed by regulations. Such
books can, under ordinary circumstances, be
obtained from the medical purveyor on requi-
sition by the surgeon. The form is as fol-
lows : —
124
THE HOSPITAL STEWARDS MANUAL.
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THE HOSPITAL STEWARD'S MANUAL. 125
This register should be carefully kept. The
names of patients should be entered imme-
diately on their admission, with their rank,
regiment, and company, and the number of the
ward and bed. The diagnosis should not be
entered until subsequently, and never by the
steward or clerk upon his own responsibility, but
only on instructions received from the surgeons.
The steward should look over the register
once, weekly, and, whenever omissions exist in
the diagnosis, should present the book to the
surgeons in charge of the several wards, for
the necessary entries.
The subsequent columns, of course, can only
be filled up on the termination of the case.
The register thus kept furnishes the data
from which the monthly and quarterly reports
of sick and wounded are made out.
In large general hospitals some additional
means should, however, be resorted to, to
enable friends or others looking for indivi-
dual patients to find them without difficulty.
To effect this purpose, an alphabetical in-
dex to the register must be kept, in which
will be entered the name, regiment, and com-
pany of each patient, with the page of the
register on which his name is to be found.
11*
126 THE HOSPITAL STEWARD'S MANUAL.
As the Prescription and Diet Book, as well as
the Case Booh, are kept by the surgeon in per-
son, it is not necessary to discuss them in this
work.
The Meteorological Register. — Keeping this
register is a duty which, although supposed to
be performed by the surgeon, is frequently
executed by the hospital steward under his
supervision. Books properly ruled for this pur-
pose are obtained on the surgeon's requisition
upon the medical purveyor. Where the meteo-
rological record is kept by the steward, the sur-
geon will always make full explanations as to
the manner in which this duty is performed,
and will supervise his procedures from time to
time, to ascertain their correctness. The subject
need not, therefore, be entered into in detail.
The copies of requisitions, annual returns,
and quarterly reports of sick and wounded are
to be kept carefully on file.
The Order and Letter Book is to retain copies,
not merely of all letters and reports received,
but of all written by the surgeon in charge, on
official business.
Besides these records prescribed in regula-
tions, it will be found convenient to keep
among the hospital books three separate lists
THE HOSPITAL STEWARD'S MANUAL. 127
of discharges, furloughs, and deaths. In a large
hospital each of these subjects should have a
special book devoted to it.*
The Muster and Pay Rolls of the cadets, hos-
pital stewards, female nurses, matrons, and of
soldiers in hospital, sick or on duty, are made
out every two months by one of the clerks or
hospital stewards. When it is completed, it is
signed by the surgeon in charge, after having
carefully inspected it, and mustered the patients
and attendants to satisfy himself that the rolls
are perfectly correct.
For the forms of these several rolls, see
Part I.
Of Passes. — Patients or attendants desiring
to leave the hospital for any purpose, must
obtain a written pass from the surgeon on duty
as officer of the day, or from the surgeon in
charge, under such rules and regulations as
may be established for each hospital.
SECTION IX. THE KNAPS ACK-ROOM.
The knapsack-room is a place set apart for
the safe keeping, not only of the knapsacks,
* See Pai't II. chap. iii.
128 THE HOSPITAL STEWARD'S MANUAL.
but of the overcoats, blankets, and other pro-
perty of the patients, and of their arms and
accoutrements when they are brought with
them to the hospital.
It should be a secure apartment, of sufficient
size, shelved on all sides and furnished with an
arms-rack for the arms.
Certain shelves should be set aside for each
ward. On these the knapsacks should be
neatly arranged. Each should be carefully
and regularly packed, the articles having been
first well cleaned or washed, if necessary. A
label should be attached, having written legibly
upon it the name of the owner, with his regi-
ment and company. Great-coats and blankets
should be neatly folded and strapped upon the
knapsack.
Arms should be placed in order upon the
arms-rack, and a similar label attached to each
musket, sabre, belt, &c.
Patients on going to hospital should, how-
ever, when possible, leave their arms and
accoutrements with their companies, and on
no account take ammunition into the hospital.*
The care of the knapsack-room, the reception
* Revised Regulations, Art. XLIV. \ 1251.
THE HOSPITAL STEWARD'S MANUAL. 129
of the articles from the patient, and their due
delivery to him when he leaves the hospital,
are duties for the proper performance of which
the ward-master to whom they are intrusted
is responsible to the steward. The knapsack-
room should be opened from time to time
swept, dusted, and well aired.
SECTION X. THE LAUNDRY.
The washing of hospitals is a subject of
very considerable importance, and requires
careful supervision. Whenever practicable, it
should be done in the hospital, in a room set
aside for that purpose and designated as the
laundry. The washing should never be given
out when it can be avoided. Want of punc-
tuality and of resjDonsibility on the part of the
laundresses are the objections.
The laundresses are appointed by the surgeon
in charge of a general hospital. Soldiers' wives
should have the preference. They receive for
their services $6 per month, with one ration
per day.
Laundresses are usually employed in general
hospitals in the proportion of one to every
twenty beds. In the practical duties of their
130 THE HOSPITAL STEWARD'S MANUAL.
service the best results will be attained if the
matron in charge of the linen-room issues a
certain number of pieces to each as her day's
task, holding her responsible for their proper
condition when returned.
Washing for a great hospital is probably best
and most economically effected by steam, as is
practised in various British military and naval
establishments.
At the present time, however, there are few
establishments in the United States which
possess the necessary apparatus for this pur-
pose, and the washing has to be effected in a
much simpler manner.
Large-sized caldrons, holding about fifty
gallons, with a small furnace attached, are
issued by the medical purveyors or the quar-
termaster, for the purpose of boiling those
articles which require this treatment. The
washing is effected in troughs made for the
purpose, or in ordinary wash-tubs, as the case
may be. Washing-machines of various sorts
are used in some of the hospitals. The pro-
cesses will necessarily vary so much in accord-
ance with the apparatus supplied to the hospital,
that no general rules can be laid down in this
place. It need only be said that the clothes
THE HOSPITAL STEWARD'S MANUAL. 131
are to be washed clean, without exposing them
to unnecessary violence, carefully dried, and
neatly ironed.
The furniture of the laundry should consist,
according to the size of the hospital, of one
or more clothes-boilers (fifty-gallon caldrons),
with furnace attached, one or more stoves for
heating smoothing-irons, for which a special
stove is issued by the medical purveyor, and of
a sufficient number of wash-tubs, which may be
either fixed troughs of wood lined with tin or
zinc, with the faucets for hot and cold water
supply immediately over them, or, where this
is not attainable, may be simply round tubs
of the ordinary pattern, set upon benches of
convenient size.
There will be needed, besides, wash-boards,
ironing-boards, ironing-tables, and smoothing-
irons.
The laundry should be in charge of one of
the laundresses, designated for the purpose.
She should be responsible for its order and
neatness, should give general superintendence
to the work, and be authorized to issue the
necessary directions to insure its efficient exe-
cution.
132 THE HOSPITAL STEWARD'S MANUAL.
SECTION XL THE LINEN-ROOM.
The room in which the clean bedclothes,
under-clothes, &c. are stored when not in use,
is generally called the linen-room; and this
designation may be conveniently retained,
although a large majority of the articles stored
away are made of muslin or other materials,
and not of linen.
The linen-room should be shelved round
conveniently for the reception of the articles
stored, and should be furnished with a lock
and key for security. It should be placed in
charge of a female nurse, with one or more
assistants, according to the size of the insti-
tution.
On taking charge of the linen-room, the
nurse should be furnished with a list of the
articles intrusted to her care, which she should
verify by personal inspection. Subsequently,
she should keep a memorandum-book, in
which the chief nurse of each ward should be
charged with all articles issued to him for his
ward, and credited by all soiled articles re-
ceived from him at the soiled-clothes closet,
which should also be under her charge, so that
she shall superintend on the one hand the
THE HOSPITAL STEWARD'S MANUAL. 133
issue of clean articles to the ward, and their
return soiled, and on the other the issue of
soiled articles to the laundresses, and their re-
turn clean.
But in neither case should she allow articles
to go out of her hand without a memorandum
made, setting forth the number of each article
issued, and the person responsible.
The chief articles which will thus pass
through her hands are —
Sheets, coverlets, blankets, bed-sacks, pillow-
cases, towels, mosquito-nets, and hospital suits,
consisting of shirts, drawers, and socks. All
these articles should be marked U. S. Hosp.
Dept., with indelible ink.
Besides these articles of hospital property, it
is usual for the soiled clothes of patients to be
washed in the laundry.
The female nurse in charge of the linen-
room, with her assistants, should also be re-
quired to see that the articles are in a proper
state of repair, and, if not, to mend them care-
fully before issuing.
12
134 THE HOSPITAL STEWARD'S MANUAL.
CHAPTER III.
Admissions, Discharges, Deaths, &c.
SECTION I. ADMISSION OF PATIENTS.
Patients are to be received into hospitals
only when sent there by competent authority,
except in extreme cases, in the discretion of the
surgeon.
Each patient should be accompanied by the
written order for his admission, and by his
descriptive list.
The patients are received either by the
steward, or by a medical officer detailed for
that duty (the medical officer of the day).
If the patient is able to walk, he is taken
into the office, and his name, rank, regiment,
or corps, and the date of admission, entered in
the hospital register. His effects are then
turned over to the ward-master (and his mo-
ney or any valuables given to the surgeon for
safe keeping) ; after which he is taken to the
bath-room, thoroughly cleansed, his head and
clothes examined for vermin, and measures
taken for their destruction if any are observed.
THE HOSPITAL STEWARD'S MANUAL. 135
He is then taken to the ward and bed assigned
to him.
A ticket has meantime been made out for
him in the office, which contains on its face his
name, rank, regiment or corps, company, and
date of admission, with a blank space, on which
the surgeon may enter the diagnosis.
On the reverse is a list of his effects. The
form adopted by the medical department for
these tickets is as follows : —
136 THE HOSPITAL STEWARD'S MANUAL.
(Face of the Ticket.)
Number of Bed :
Name:
Company:
Regiment :
Disease or Injury.
Date of Admission.
Date of Discharge.
Where Sent, and by what Authority.
THE HOSPITAL STEWARD'S MANUAL. 137
{Reverse.)
CLOTHING, &c.
Knapsacks. .
Great Coat. .
Blanket. . .
Uniform Coat
Undress Coat
Trousers. .
Shirts. . . .
No.
Drawers, prs.
Bootees, prs.
Boots, prs. .
Stockings, prs
Money. . .
No.
12*
138 THE HOSPITAL STEWARD'S MANUAL.
This ticket, properly filled up, is placed at
the head of the patient's bed, where it is to
remain so long as he remains in hospital. It
may simply be fastened to the wall with a
tack; but it is more convenient to have a little
tin plate, with the edges on three sides turned
over, so as to form a frame, into which the
ticket may be slipped. The frame to be fas-
tened to the head-piece of the bed, or hung
upon the wall above it.
Tickets printed in blank for this purpose, as
well as the frames, may be purchased by the
surgeon out of the hospital fund, when not
supplied by the purveyor.
When the patient is unable to walk, the
steps to be taken are essentially the same,
modified only in accordance with the necessity
of the case. He is to be taken carefully from
the ambulance in which he was brought to the
hospital, by gently drawing out the litter on
which he lies, and laying it upon the ground.
He is then transferred to a hand-stretcher and
carried into the hospital. If his condition is
such that it is not advisable to bathe him, — of
which, whenever practicable, a medical officer
should be the judge, — he should be carried at
once to the ward and bed assigned him, un-
THE HOSPITAL STEWARD'S MANUAL. 139
dressed, and put into the bed, taking such
measures to secure cleanliness, by washing the
head, hands, and feet, changing the under-
clothes, &c, as may be possible under the
circumstances. If the patient is severely
wounded, and especially if bones are fractured,
the greatest care should be employed in han-
dling him, and in carrying the stretcher. The
stretcher should be carried by two strong at-
tendants, who should be directed to step off in
such a manner that when the foremost puts
his right foot forward the hindmost shall put
forward his left : by so doing, much unneces-
sary jolting and tilting of the stretcher will be
avoided.
If stairs are to be ascended, the foremost
bearer should lower his end of the stretcher,
while the hindmost elevates his in such a
manner as to keep the patient as nearly on a
level as possible. The reverse is to be done
if stairs are to be descended.
The patient received into hosjoital should, if
thereby separated from his company so as not
to be mustered with it for pay, be accompanied
with his descriptive list and account of pay and
clothing. If this does not come with him, the
steward should at once bring the fact to the
140 THE HOSPITAL STEWARD'S MANUAL.
notice of the surgeon, who will address a note
on the subject to the company commander,
whose duty it is to furnish it.
The descriptive lists and accounts of pay
and clothing of soldiers received into hospital
are to be carefully filed away in the office of
the hospital, in order that the surgeon, as re-
quired by regulations, may enter thereon "all
payments, stoppages, and issues of clothing to
him in hospital."*
The form of the descriptive list and account
of pay and clothing is the same for enlisted
men as for hospital stewards.*}*
SECTION II.— RETURN TO DUTY TRANSFER TO THEIR
HOSPITALS FURLOUGHS AND DISCHARGES.
The patient thus received into hospital may
either recover, remain incurable, or at least
permanently disabled, or may die.
If he recovers, he will be sent back imme-
diately to his company by the surgeon, unless
otherwise directed by proper authority. When
sent back to his company, the date is entered in
the register under the head " returned to duty."
* Revised Reg., Art. XLIV. \ 1250.
t See Part I. Chap. I. \ 3.
THE HOSPITAL STEWARD'S MANUAL. 141
Sometimes, on account of the crowded or
unhealthy state of the hospital, he is trans-
ferred to another hospital. This is usually
done by order of the medical director of the
military district, on application of the surgeon
in charge, or otherwise. In this case, the
date should be entered in the register under
the head "sent to general 7wspital" and a
memorandum should be made in the column
of remarks of the hospital to which he is sent
and the authority by which the transfer was
made.
When it is deemed desirable in tedious cases,
or during convalescence, the patient may be
allowed to leave the hospital on furlough.
The furlough is obtained on application made
to the commanding officer by the surgeon, ac-
companied by a certificate of the nature of the
complaint in consequence of which the appli-
cation is made, and setting forth the time which,
in the surgeon's opinion, must elapse before he
will be fit for duty. When a patient leaves
the hospital on furlough, the date should be
entered in the hospital register in the column
" on furlough? The time for which the furlough
is granted should be entered in the column of
remarks.
142 THE HOSPITAL STEWARD'S MANUAL.
If the patient is believed by the surgeon to
be suffering from such a complaint or disability
as to justify his discharge from service, he
makes out a " certificate of disability for dis-
charge," in accordance with the prescribed form,
Med. Regulations, Form 13, and forwards it to
the proper authority, as directed in army
regulations.*
When the patient is discharged from service,
the date will be entered in the register in the
column " discharged from service" and the
reasons set forth in the certificate of disability
are to be entered in the column of remarks.
When the patient leaves the hospital, " the
medical officer shall certify and remit his de-
scriptive list, showing the state of his accounts.
If he is discharged from service in hospital,
the surgeon shall make out his final statement
for pay and clothing."-j*
Patients may also occasionally desert from
hospital. Every patient who remains absent
from hospital, without leave, for more than
three days, should be regarded as a deserter.
A separate column in the register of patients,
* Kevised Reg., Art. XIX.
t Revised Reg., Art. XLIV. 1 1250.
THE HOSPITAL STEWARD'S MANUAL. 143
marked "deserted" is prepared for the entry
of the date of desertion.
SECTION III. OF DEATHS.
When a patient dies in hospital, the corpse
should not be allowed to remain in the ward,
but be at once removed to some convenient
place assigned for its reception.
Almost all general hospitals have an apart-
ment or separate building (the dead-house) set
aside for this purpose.
The greatest decency and decorum should
characterize these measures, and every respect
should be paid by the attendants to the corpse.
If desired, the body may be delivered to the
friends of the deceased by the surgeon. If not,
he at once applies to the quartermaster for
means of burial.
When a patient dies in hospital, the surgeon
is directed, by regulations, to take charge of
his effects in trust for his legal representatives,
and to "make the reports required in the
general regulations concerning soldiers who
die absent from their companies."*
* Revised Regulations, Art. XLIV. g 1250. See also Art.
XVII. g 152.
144 THE HOSPITAL STEWARD'S MANUAL.
The date of death is to be entered on the
hospital register, in the column marked died.
The following regulations have been issued
by the War Department on the subject : —
Regulations for Military Burials and the Regis-
tration of Deceased Soldiers and their Graves.
The friends of deceased soldiers desire that
accurate and permanent registration be made
of date, place of burial, transfers of corpse, and
official orders respecting interment, to enable
them to find the grave, and such records as
are important for purposes of identification.
To attain these ends —
First. The hospital in which the soldier dies
must preserve a sufficient and proper record.
Second. The Adjutant-General's office should
receive a perfect duplicate of the same, as the
records of that office would be more permanent
than those of the hospitals or the cemeteries.
Third. The sextons, whether of churches or
of military or other public cemeteries, should
have permanent records, which shall always
be accessible to the friends of the deceased.
The records of each of these officers should
be kept alphabetically indexed for reference.
Each grave should have its number, in the
THE HOSPITAL STEWARD'S MANUAL. 145
order of interments, distinctly indicated upon
a post or plank of cedar or some other enduring
wood. The name of deceased, the date of
death, and his company or regimental corps
initials, should, if possible, be engraved upon
the said post or plank. This should be effected
with an iron letter-brand or stamp. These posts
or head-boards, and the lettering of the name,
&c, will be provided by the quartermaster of
the department or military post where the
hospital is located or where the death occurs.
THE DUTY OF MILITARY SURGEONS.
In accordance with the accompanying order
of the Secretary of War, it becomes the duty
of the senior surgeon for the hospital or the
military company in which a soldier dies, im-
mediately after the death, to cause the copies
of Record — 1, 2, and 3 — to be accurately made
out, and to forward copy No. 3 to the quarter-
master, or, in the absence of a quartermaster,
to the commanding officer of the division or
company in which the death has occurred.
Copy No. 2 shall be forwarded without delay
to the Adjutant-General at Washington, by
the surgeon, or by such other officer as the
commander may designate. Generally, except
13
146 THE HOSPITAL STEWARD'S MANUAL.
in the District of Columbia, it will be the sur-
geon's duty to forward copy No. 2 to the local
adjutant or commanding officer, who, after
noting the contents, will place his signature
upon the face of the surgeon's notification
attached, and immediately forward it to the
Adj utant-General.
Whenever a military hospital is finally bro-
ken up or vacated, the hospital records should
all be transmitted to the Surgeon-General's
office at Washington, and they must ever be
open to the inspection of the friends of the
deceased.
THE DUTY OF SEXTONS.
The sexton must be directed to preserve the
records and the orders sent to him by the
quartermaster. He must also be required to
attend to the planting of the head-board or post
furnished by the quartermaster for the grave
of the deceased.
In all cemeteries in which deceased soldiers
are interred, the burials should, if practicable,
be made in regular series, occupying a separate
plat of ground; but if otherwise and promis-
cuously interred, the numbers and description
THE HOSPITAL STEWARD'S MANUAL. 147
of the locality of the grave should be carefully
recorded by the sexton.
The sexton should be required to notify the
physician of the hospital of the number and
locality of the grave before he takes the corpse.
In the case of a military burial at an en-
campment or upon a march, without the aid
of a sexton, it shall be the duty of the com-
manding officer of the military corps to which
the deceased belonged to cause his remains to
be properly interred, and to provide suitable
means for marking the grave and erecting
a head-board with the proper inscription or
stamped record. And, in the absence of a
sexton, it shall be the duty of the adjutant or
the commander of the said military corps to
preserve the sexton's copy of record; and it
will also be the duty of the surgeon to said
corps to preserve the hospital copy of said
record with the same care, and subject to the
same conditions, as similar records in general
or post hospitals.
In accordance with the foregoing regulations,
the following forms are furnished : —
148 THE HOSPITAL STEWARD'S MANUAL.
Hospital Record, subject to the order of the Surgeon-
General of the United States Army.
No. 1.
RECORD OP DEATH AND INTERMENT.
Name and number of person interred
Number and locality of the grave
Hospital number of the deceased
Regiment, rank, and company
Residence before enlistment
Conjugal condition (and if married, ~)
the residence of the widow) j
Cause of death ")
Age of the deceased
Nativity
References and remarks.
Date of death and burial.
186
Duplicates sent to the Adjutant-General of the United States
Army, and to the Sexton of the
Cemetery.
Memoranda .
THE HOSPITAL STEWARD'S MANUAL. 149
Copy of Record for the Adjutant- General, U. S. A.
No. 2.
RECORD OF DEATH AND INTERMENT.
Name and number of person interred
Number and locality of the grave
Hospital number of the deceased
Regiment, rank, and company
Residence before enlistment
Conjugal condition (and if married, ~)
the residence of the widow) J
Cause of death ~)
Age of the deceased
Nativity
References and remarks.
Date of death and burial.,
186
A duplicate of this Record has been forwarded to the Sexton, and another
remains at this Hospital.]
To
Sir:
It becomes my duty to inform you that the person above
described died at this hospital as herein stated; and that it is
desired his remains should be interred with the usual military
honors.
Respectfully,
Military Hospital,
Surgeon U. S. Army.
This copy of Record is to be transmitted to the Adjutant-General at Washing-
ton immediately after the place of burial and the number of the grave have
been ascertained and registered. The above notification is to remain attached.
13*
150 THE HOSPITAL STEWARD'S MANUAL.
Quartermasters Notification of Death.
To
Sir:
I have the honor to inform you that
, a of Company , Regi-
ment , died at this Hospital ,
and I would request you to make the neces-
sary preparation for the interment of his
remains as soon as practicable. The hour
for the funeral is appointed at
Surgeon U. JS. Army.
>
., 186 .
4*
THE HOSPITAL STEWARDS MANUAL.
151
The Sexton's Record and the Order for Burial.
No. 3.
RECORD OF DEATH AND INTERMENT.
Name and number of person interred
Number and locality of the grave
Hospital number of the deceased
Regiment, rank, and company
Residence before enlistment
Conjugal condition, (and if married, ")
the residence of the widow) j
Cause of death ")
Age of the deceased
Nativity
Remarks and references.
Date of death and burial.
186
To
The Sexton of.
You will receive, and immediately inter, the remains of the
person above described, and preserve this record, and also attend
to the setting of the head-board at the grave, as provided by the
Government and ordered by the Secretary of War.
[Burial from the
Quartermaster.
This order for the burial is to remain attached to the Sexton's copy of Record
as part of the record.
PART III.
EOOD FOE THE HOSPITAL AND ITS PEEPA
.RATION.— THE KITCHEN AND ITS MAN-
AGEMENT.
153
CHAPTER I.
Provision Keturns— Hospital Stores— Purchases for
the Hospital— The Hospital Fund and its Man-
agement.
SECTION I. PRELIMINARY.
The financial principle upon which the hos-
pitals of the United States armies are managed
is, that sick soldiers in hospital ought not to
cost more to the government than soldiers in
the field ; and, practically, it is found that the
fund created by savings upon the full ration is
amply sufficient, if properly managed, to suffice
for the purchase of all those little comforts and
delicacies which are necessaries for the sick.
The mode of procedure upon this subject
directed in the Revised Regulations is as fol-
lows : —
The hospital is credited on the books of the
commissary from which it draws its rations
by the whole number of complete rations due
throughout the month at the contract or cost
price. It draws from the commissary only
so much of each article issued by him as is
155
156 THE HOSPITAL STEWARD'S MANUAL.
actually required for the use of the sick and
the attendants : this is charged against the
hospital at the contract or cost price. The
balance left, after deducting the total cost of
provisions actually issued to the hospital from
the total cost of the rations to which it is
entitled, constitutes the "hospital fund," and
this or any portion of it may be expended
under the direction of the medical officer for
any articles necessary either for the diet or
for the comfort of the sick which are not au-
thorized to be otherwise furnished.
As the economical management of the rations
and the consequent creation of a hospital fund
depends to a great extent upon the steward,
an expose of the details of the system is here
introduced, which, it is believed, will be found
sufficiently complete.
SECTION II. OF THE RATION.
The ration authorized by army regulations
is composed of the following articles and
quantities : —
the RATION.,.
" The ration is ^three-fourths of a pound of
pork or bacon, or one and a fourth pound of
THE HOSPITAL STEWARD'S MANUAL. 157
fresh or salt beef; twenty-two ounces of bread
or flour, or one pound of hard bread, or one
and a fourth pound of corn meal ; and at the
rate, to every one hundred rations, of eight
quarts of beans or peas and ten pounds of rice
or hominy ; ten pounds of green coffee, or
eight pounds of roasted and ground coffee, or
one and a half pound of tea ; fifteen pounds of
sugar; four quarts of vinegar; one pound of
sperm candles, or one and a fourth pound
of adamantine candles, or one and a half
pound of tallow candles ; four pounds of soap,
and two quarts of salt. In addition to the
foregoing, there is allowed twice per week one
gallon of molasses per one hundred rations,
and thrice per week, if practicable, an issue of
potatoes, at the rate of one pound per man.
When beans, peas, rice, hominy, or potatoes
cannot be. issued in the proportions given
above, an equivalent in value shall be issued
in some other proper food. Desiccated pota-
toes, or desiccated mixed vegetables, at the
rate, per one hundred rations, of one hundred
and fifty ounces of the former, or one hundred
ounces of the latter, may be substituted for
beans, peas, rice, hominy, or fresh potatoes.
when these articles cannot be issued ; or, upon
u
158 THE HOSPITAL STEWARD'S MANUAL.
the requisition of the proper officer and when
the supply on hand will admit of it, they may
be issued at the foregoing rate, twice per week,
in lieu of beans or peas, or in lieu of rice or
hominy. Fresh beef may be issued as often
as the commanding officer of any detachment
or regiment may require it, when practicable,
in place of salt meat."*
Note. — "After the present insurrection shall cease, the
ration shall be as provided by law and regulations on the first
day of July, eighteen hundred and sixty-one." (Section 13,
Act approved August 3, 1861.) To wit, as follows: —
" The ration is three-fourths of a pound of pork or bacon, or
one and a fourth pound of fresh or salt beef; eighteen ounces
of bread or flour, or twelve ounces of hard bread, or one and a
fourth pound of corn meal ; and at the rate, to one hundred
rations, of eight quarts of beans, or in lieu thereof, ten pounds
of rice, or in lieu thereof, twice per week, one hundred and
fifty ounces of desiccated potatoes, and one hundred ounces of
mixed vegetables ; ten pounds of coffee, or in lieu thereof, one
and one-half pound of tea ; fifteen pounds of sugar ; four quarts
of vinegar ; one pound of sperm candles, or one and one-fourth
pound of adamantine candles, or one and one-half pound of
tallow candles ; four pounds of soap, and two quarts of salt."f
* New Regulations of Subsistence Department, 1862.
f Revised Army Reg. 1861, Art. XLIII. \ 1191.
THE HOSPITAL STEWARDS MANUAL.
159
According to existing laws, therefore, the
ration for the duration of the rebellion may be
tabulated as follows : —
Either may be drawn, f
or a part of each. Pork
Thus, of 100 rations, J Bacon
60 may be fresh beef, 1 Salt beef.....
and 40 pork or ba- Fresh beef.,
con. [
Either may be drawn, J Fiour \
or a part o each. |Hard bread.":'...
*»- {b^s=:::::::
May be substituted f De^ted pota"
for rice or beans, if I Desic.ted"mix'ed
deslred- [ vegetables
If practicable Potatoes
Tea may be substi- f
tuted for coffee, on) Coffee
requisition of thel Tea
proper officer. |_
Sugar
Vinegar
(Sperm candles...
Adamantine
candles
Tallow candles..
Soap
Salt
For
For
one man.
100 men.
Jib.
Daily.
75 lbs.
l£lb.
Daily.
125 lbs.
22 oz.
Daily.
137i lbs.
lib.
Daily.
100 lbs.
1.6 oz.
0.64 gills.
Daily.
Daily.
10 lbs.
8 quarts.
1.5 oz.
Bi-weekly.
9 lbs. 6 oz.
1 oz.
lib.
Bi-weekly.
Tri-weekly.
6 lbs. 4 oz.
100 lbs.
1.6 oz.
0.24 oz.
Daily.
Daily.
10 lbs.
1 lb. 8 oz.
2.4 oz.
0.32 gills.
0.16 oz.
Daily.
Daily.
Daily.
15 lbs.
4 quarts.
lib.
0.20 oz.
0.24 oz.
0.64 oz.
0.16 gills.
Daily.
Daily.
Daily.
Daily.
li lbs.
li lbs.
4 lbs.
2 quarts.
Occasional issues (extra) of molasses are
made of two quarts to one hundred rations.
Peas or hominy are sometimes issued instead
of rice or beans. The following table shows
the quantities in bulk of each article in from 1
to 100,000 rations :
160
THE HOSPITAL STEWARDS MANUAL.
Table showing the Quantity in Bulk of any
£
PORK.
BEEF.
FLOUR.
BEANS OR PEAS.
RICE, HOMINY,
ANB *GREEN
COFFEE.
TEA.
o
■<
a
Eh
©
05
W
a
a
p
*5
a
3
o
CD
0
=1
o
•5
a
3
o
a
3
o
u
■a
H
o
P4
o
a
3
o
3
u
3
3
■a
a
3
o
ft
3
3
o
■a
3
3
o
3
3
o
1
37
375
1
2
3
3
4
5
6
6
7
15
22
30
37
45
52
60
67
75
150
100
12
8
4
12
8
4
12
8
8
8
8
8
1
2
3
5
6
7
8
10
11
12
25
37
50
62
75
87
100
112
125
1,250
12,500
125,000
4
8
12
4
8
12
4
8
8
8
8
8
7
70
701
1
2
4
5
6
8
9
11
12
13
27
41
55
68
82
96
110
123
137
3
30
104
6
12
2
8
14
4
10
6
12
8
4
12
8
4
12
8
0.64
1.28
1.92
2.56
3.20
3.84
4.48
5.12
5.76
6.40
4.80
3.20
1.60
1.6
3.2
4.8
6.4
8.0
9.6
11.2
12.8
14.4
1
1
1
1
15
150
1500
0.24
0.48
0.72
0.96
1.20
1.44
1.68
1.92
2.16
2.4
4.8
7.2
9.6
12.0
14.4
0.8
3.2
5.6
8.0
2
3
4
5
6
7
8
9
10
1
2
3
4
5
6
7
8
9
10
100
1,000
10,000
20
30
40
50
2
25
250
1
2
3
4
4
5
6
7
8
16
60
70
6.40
4.80
3.20
1.60
80
90
100
1,000
10,000
100,000
Note. — Fresh potatoes are issued, three times per week, at one pound to the ration; fresh
flour, when on hand for issue, 12£ pounds to the 100 rations in lieu of beans or peas ; molasses, one
* Roasted or ground coffee is issued at the rate of eight pounds to the 100 rations.
f Sperm candles are issued at the rate of one pound, and tallow candles at the rate of one pavnd
THE HOSPITAL STEWARDS MANUAL.
Number of Rations, from 1 to 100,000.
161
SUGAR.
VINEGAR AND
MOLASSES.
fADAMAN-
TINE
CANDLES.
SOAP.
SALT.
DESICCATED
POTATOES.
MIXED
VEGETABLES.
■3
s
3
o
<v
o
3
3
O
a
o
©
3
s
■a
3
3
o
Hi
1
1
1
12
125
1250
3
3
O
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
1.8
2.
4.
6.
8.
10..
12.
14.
2.
4.
8.
•a
a
3
o
o
3
3
o
3
3
5
■a
3
3
o
c
3
O
•3
3
3
o
o
3
3
o
2.4
4.8
7.2
9.6
12.0
14.4
0.8
3.2
5.6
8.0
8.0
8.0
8.0
8.0
0.32
0.64
0.96
1.28
1.60
1.92
2.24
2.56
2.88
3.20
6.40
1.60
4.80
3.20
6.40
1.60
4.80
1
1
2
2
3
3
4
40
400
4000
0.64
1.28
1.92
2.56
3.20
3.84
4.48
5.12
5.76
6.40
12.80
3.20
9.60
6.40
12.80
3.20
9.60
0.16
0.32
0.48
0.64
O.SO
0.96
1.12
1.28
1.44
1.60
3.20
4.80
6.40
1.5
3.0
4.5
6.0
7.5
9.0
10.5
12.0
13.5
15.0
14.0
13.0
12.0
11.0
10.0
9.0
8.0
7.0
6.0
12.0
8.0
1
2
3
4
5
6
1
7
1
8
1
9
1
10
s
4
1
10
100
1000
1
1
2
2
2
3
3
1
2
3
4
5
6
7
8
9
93
937
9,375
1
1
2
3
3
4
5
5
6
62
625
6,250
4
14
6
8
7
6
62
1
1
1
1
1
2
20
8
16
2
9
10
12
13
15
1.60
3.20
4.80
6.40
12
6
10
4
150
8
1 500
15 000
onions, when on hand for issue, three bushels in lieu of one bushel of beans or peaB; bein
gallon to the 100 rations, twice per week.
and a half, to the 100 rations.
14*
162 THE HOSPITAL STEWARD'S MANUAL.
SECTION III. OF PROVISION RETURNS.
Provisions are drawn for the hospital from
the commissary on a provision return,* blank
forms for which are furnished by the commis-
sary for that purpose.
It should represent the total quantity of
each article to which the hospital is entitled,
the quantity of each actually drawn, and the
quantity of each retained by the commissary,
which is to be credited to the hospital by him.
The provision return must be signed by the
surgeon in charge, and by the commanding
officer having authority to direct the issue.
The following is the form: —
* Form 13, Subsistence Depart., Eevised Reg., p. 267.
THE HOSPITAL STEWARDS MANUAL.
163
i s-
Total rations
Total actually
>■
S
as
1 1 1
Number of Men.
1 1 1
Number of Women.
1 1 1
Total.
1 1 1
Number of Days.
1 1 1
Number of Rations.
1 1 1
Pork.
SO
>
S
o
T
1 1 1
Salt Beef.
1 1 1
Fresh Beef.
1 1 1
Flour.
1 1 1
Beans.
1 1 1
Bice.
1 1 1
Coffee.
1 1 1
Tea.
1 1 1
Sugar.
1 1 1
Vinegar.
1 1 1
Sperm Candles.
1 1 1
Adamant. Candles.
1 1 1
Soap.
1 I 1
Salt.
1 1 1
Potatoes.
1 1 1
Molasses.
1 1 1
&c.
1 1 i
1 1 1
Here specify tho
number of ca-
dets, stewards,
female nurses,
guards, attend-
ants, patients,
and total.
SI
w
I
3
g
•J
^
s>
s
c*>
M
/J
o*
1
fcq
a
Rg
2
a
Ai
"a*
t
a.
<3
164 THE HOSPITAL STEWARD'S MANUAL.
The provision return is made out by the
hospital steward, and is based upon his know-
ledge of the actual needs of the hospital : sortie
experience is needed to enable him to draw
the proper quantity of each article, and no
absolute rule can be laid down, as the amount
needed will vary to a considerable extent, in
accordance with the proportion of severe cases
of disease or injury in the hospital. In all
doubtful cases it is better to draw too much
than too little ; for the patients must never he
stinted in any thing for the sake of making
hospital fund, and, if there is a surplus, so
much less may be drawn on the next return.
After having made out the provision return,
it is carried by the hospital steward to the
surgeon for his approval and signature, and
afterwards to the commanding officer.
The return, having been approved, is carried
by the steward with the hospital wagon to
the commissary, the provisions obtained and
brought to the hospital.
Duplicate copies of the provision returns
should be kept on file by the steward, in order
that they may be compared with the monthly
statement of the hospital fund, furnished by
the commissary to the surgeon.
TIIE HOSPITAL STEWARD'S MANUAL. 165
At all posts where there is an army bakery,
it is usual for the hospital to draw bread in-
stead of flour. This is effected as follows: —
When drawing the ration, the steward receives
from the commissary an order for the number
of rations of bread his provision return calls
for; one ration of flour being regarded as the
equivalent of a ration of bread, weight for
weight. The steward carries the order to the
bakery and receives the bread. Where the
bakery bakes daily, it is usual for the steward
to draw each day only the number of loaves
required for the following twenty-four hours,
instead of drawing the whole amount at once.
In like manner, when fresh beef is drawn,
the steward does not generally receive the
fresh beef from the commissary, but an order
for it, which he carries to the shamble, desig-
nated by the commissary, and there receives
the beef. In warm weather the steward should
not draw at once the whole amount, but, learn-
ing the days on which animals are butchered,
should procure each butchering-day the portion
necessary to last to the next. If butchering
is done daily, the meat should be procured
daily, using each day meat killed the day
before.
166 THE HOSPITAL STEWARD'S MANUAL.
SECTION IV. OF HOSPITAL STORES.
Besides what can be obtained from the com-
missary, certain articles needed for the diet
of the sick are obtained from the medical pur-
veyor, under the title of hospital stores. These
articles are enumerated in "regulations" as
arrow-root, barley, cinnamon, cloves, cocoa,
farina, ground Jamaica ginger, nutmegs, tea,
whiskey, and wine.
These articles are obtained by requisitions
on the medical purveyor, made by the surgeon
and approved by the medical director or the
Surgeon-General, in accordance with the regu-
lations which will be hereafter described
under the head of " Requisitions for Medical
and Hospital Supplies."
SECTION V. — OF PURCHASES FOR THE HOSPITAL.
All articles needed for the subsistence of the
sick in hospital, which cannot be obtained
from the commissary or the medical purveyor,
are purchased out of the hospital fund, out of
which are also purchased all such other arti-
cles needed for the comfort of the sick as are
THE HOSPITAL STEWARD'S MANUAL. 167
not authorized to be obtained in any other
way.
Purchases for the subsiste?ice of the sick may
be divided into two classes.
First, purchases necessary to complete the
ordinary "full diet table," as adopted by the
surgeon in charge for his hospital, such as
milk, butter, fresh vegetables, e.g. cabbage,
onions, turnips, &c, mustard, pepper, dried
fruit, sour-krout, and all similar articles. Ice
comes also under this head.
Secondly, purchases necessary for the "extra
diet" ordered by the surgeon in special cases,
such as eggs, oysters, chickens, fresh fruit,
oranges, lemons, malt liquors, &c. &c.
These articles will be referred to hereafter,
in connection with the question of "Diet and
Cooking."
Purchases for the comfort of the sick may
include a great variety of articles, as purchases
of oil, or expenditures for gas for lighting the
hospital, hospital furniture which cannot be
obtained by requisition on the medical pur-
veyor, as window-shades, water-coolers, &c.&c,
printed blanks for passes, discharges, labels,
printed rules and regulations, &c. &c.
The authority for making these purchases
168 THE HOSPITAL STEWARD'S MANUAL.
is granted in regulations in the folloAving
terms : —
" The hospital fund, or any portion of it, may-
be expended by the commissary, on the re-
quisition of the medical officer, in the pur-
chase of any article for the subsistence or
comfort of the sick, not authorized to be
otherwise furnished."*
Practically, the purchases for the diet of the
hospital are generally made for large general
hospitals in the following manner : —
A purveyor for the hospital is designated by
the surgeon in charge. The purveyor should,
if possible, be some respectable produce-dealer
in the neighborhood of the hospital. Each
morning, or as often as necessary, the steward
makes out a list of the articles needed, obtains
the approval of the surgeon in charge, and
sends it to the dealer, who procures the articles
and sends them to the hospital. A special
memorandum-book should be kept by the stew-
ard, in which he should keep copies of these
lists for comparison with the articles actually
furnished on their arrival, as well as for com-
parison with the monthly bill. It will be
* Revised Reg., Art. XLIII. \ 1195.
THE HOSPITAL STEWARD'S MANUAL. 1G9
found most economical to make purchases of
all articles not immediately perishable in suf-
ficiently large quantities to obtain the advan-
tage of wholesale price. At the end of the
month a bill is made out in duplicate, and
ajDproved by the medical officer in charge,
according to the following form : —
15
170 THE HOSPITAL STEWARD'S MANUAL.
The United States
To
Dr.
186
Dolls. Cts
I certify, on honor, that the above-specified articles were pur-
chased on my requisition for the use of the sick in hospital under
my charge.
Surgeon
Eeceived at this day of
, 186 — , from Lieut ,
A.C.S., U.S.A., Dollars and Cents,
in full of the above account.
(signed in duplicate.
Notes. — "No officer or agent in the military service shall purchase from any
other person in the military service."
Purchases for a hospital from subsistence funds may be made by a commissary
to the extent only of the " hospital fund" due such hospital, and must be limited to
articles " for the subsistence or comfort of the sick not authorized to he otherwise
furnished.'"
Medicines, regular supplies of the Quartermaster's Department, &c. &c, mrst
not be obtained from the hospital fund.
THE HOSPITAL STEWARD'S MANUAL. 171
This duplicate bill, duly approved, is given
to the dealer, who receipts it, presents it to the
commissary, and receives the money.
Printed blanks for this purpose can usually
be obtained from the commissary.
Milk for the hospital is usually best obtained
from some respectable dealer in that article,
to be designated by the surgeon in charge.
He should be paid monthly, in the manner
above described. Ice for the hospital should
likewise be procured, when possible, from an ice-
dealer, who should furnish daily the required
quantity, and be paid in the same manner.
If any of the articles thus purchased be fur-
nished of inferior quality, or if the quantity be
not fully that agreed upon and charged, or if
the charges exceed the market-price of any
article, the circumstance should be reported at
once by the steward to the surgeon in charge,
who will take such action as the circumstances
of the case demand.
Too much care cannot be exercised by the
steward in this particular. All articles re-
ceived should be at once compared with his
memorandum-book, and, if any doubt exist as
to the quantity of any thing, it should be at
once weighed or measured. Milk should be
172 THE HOSPITAL STEWARD'S MANUAL.
received in vessels of uniform size, and, if not
received by the steward in person, the attend-
ant charged with that duty should be instructed
to report to the steward, daily, immediately
after its receipt, whether the quantity is cor-
rect and the quality good. Any reported de-
ficiency should be at once investigated by the
steward, and, if found to exist, should be im-
mediately reported to the surgeon.
Unless this is done, the hospital is liable to
constant imposition.
SEC. VI. THE HOSPITAL FUND — ITS MANAGEMENT.
The management of the provision returns,
and of the purchases for the hospital, is an im-
portant and responsible part of the duties of
the hospital steward. If it be carefully per-
formed, the hospital fund will be found, under
ordinary circumstances, more than adequate
for all the necessities of the hospital, — so much
so that it is directed in regulations, that,
" At large depots or general hospitals, this
fund may be partly expended for the benefit
of dependent posts or detachments, on requi-
sitions approved by the medical director or
senior surgeon of the district." And that, on
the first of January, each year, one-fourth of
TITE HOSPITAL STEWARD'S MANUAL. 173
every "hospital fund," if less than $150, and
one-half if more, will be dropped by the com.
missary from the fund, and will be paid over
to the treasurer of the Soldiers' Home by the
Commissary-General.
Other purchases for the hospital than those
for the diet of the patients should be made
only on the direction of the surgeon, and are
to be paid for in the same manner.
The steward should keep on file copies of all
these bills, for comparison with the " monthly
statement of the hospital fund."
Under certain circumstances the commissary
has been authorized by the Commissary-General
to pay over the hospital fund in money to the
surgeon for expenditure. This course is objec-
tionable, as the surgeon becomes thus respon-
sible for public money, and is burdened with
the preparation of all the returns and vouchers
required by regulations of disbursing officers.
A copy of the monthly statement of the
hospital fund is to be made by the steward
from the abstract presented by the commissary
for the signature of the surgeon in charge.
This should be done as soon as practicable
after the close of the month, in the following
form : —
15*
174 THE HOSPITAL STEWARD'S MANUAL.
A Monthly Statement of the Hospital Fund at , for
the month of , 186 — .
Dolls.
Cts.
10
73
00
95
493 rations, being whole amount due this month, at 15 cents per
Cr. issued.
By the following provisions, at contract prices :
Dolls.
Cts.
83
43
95
2183 pounds of Fresh Beef. at 4 cei
ts per lb...
its per lb...
its per lb...
its per lb...
its per lb...
per bush...
its per lb...
its per lb...
its per lb...
ts per lb...
ts per qt...
its per lb...
its per lb...
its per lb...
its per qt...
2
7
8
9
3
2
2
25
50
75
35
75
84
50
70
36
36
27
35
60
32
6
3 pounds of Adamantine Candles.at 20 cei
PURCHASED.
Dolls.
Cts.
1
00
36
50
50
28
75
3
39
40
06
45
40
50
-, Surgeon
THE IIOSriTAL STEWARD'S MANUAL. 175
A copy of the monthly "statement oi the
hospital fund" must be filed among the records
of the hospital, and' a copy furnished to the
surgeon in charge to transmit to the Surgeon-
General.*
The amount of the hospital fund will vary
under different circumstances, and the theory
is that, ordinarily, it will vary with the wants
of the hospital. Thus, if the hospital contains
a large proportion of serious cases, there will
be a great saving on the ration, and a large
hospital fund, on which the drafts for extra
diets and other comforts for the sick will be
proportionately large. If, on the other hand,
the hospital principally contains convalescents,
there will be comparatively little saving on
the ration, and consequently a small hospital
fund, but, at the same time, the necessities
for extras to be purchased will also be com-
paratively small.
Two causes, however, will be found to in-
fluence the hospital fund, besides the character
of the cases in the hospital. The first is the
cost-price of the ration at the post ; the second
is the economy with which the purchases
* Kevised Reg., Art. XLIV. § 1264.
176 THE HOSPITAL STEWARD'S MANUAL.
for the hospital and the hospital-kitchen are
managed. As to the first cause, it is very
evident that the amount of saving in dollars
will be much larger at a post where the ration
is estimated at twenty-two cents, than where
it is estimated at fifteen cents. But, prac-
tically, it will be found that this cause
does not materially influence the amount
of purchases that can be made with the hos-
pital fund, for where the cost-price of the
ration is small, there will generally be found
cheap markets for the purchase of the extras
needed, and, on the contrary, dear markets
where the cost-price of the ration is high.
The chief cause, therefore, practically, which
influences the size of the hospital fund in its
relation to the actual wants of the hospital,
will be found to be the economy displayed in
the administration of the hospital. Economy
is secured by keeping the provisions and stores
of the hospital under lock and key, so as to
prevent all unauthorized expenditure ; by
keeping a strict account of all authorized
expenditures, and comparing from time to
time the daily expenditures with each other
and the number of patients, so as to become
at once aware of any inadvertent extrava-
THE HOSPITAL STEWARD'S MANUAL. 177
gance ; by prudence in drawing or purchasing
perishable articles, such as fresh meat, &c,
wThich should be so managed that, while there
is enough for all purposes, none should be left
over to spoil ; by skill and economy in the
management of the kitchen; (on the whole,
it may be said that bad cooking is more ex-
travagant than good cooking, requiring larger
quantities of ingredients, and giving worse
results ;) by economy with the gas, lamps, or
other means resorted to to light the hospital;
and, finally, by taking care to make the pur-
chases for the hospital of honest dealers, and
to pay for them no more than the market-
price. Twenty-five to fifty per cent, of the
hospital fund, or even rnore$ may be lost by
making the purchases of an improper person.
The hospital fund, in a properly managed
hospital, should amount to from one-fourth to
one-half of the total cost of the rations to
which the number of patients and attendants
in the hospital are entitled.
Thus, in a hospital for five hundred patients,
at a post where the ration is estimated at
eighteen cents cost-price for each full ration, the
monthly savings should be at least $650, and,
under favorable circumstances, may swell to
178 THE HOSPITAL STEWARD'S MANUAL.
$1400, or even more. When a hospital is
first established, the whole of this sum should
not be expended, the excess of savings over
expenditures being allowed to accumulate till
it forms a sum at least as large as the monthly
savings, after which there need never be any
hesitation in expending each month, for the
comfort of the sick, all the savings of the
month previous.
That the above estimate is not excessive
may be proved by a single example from
among many. In the Seminary Hospital,
Georgetown, D.C., under the efficient manage-
ment of Assistant Surgeon (now Surgeon) J.
K. Smith, U.S.A., during the year subsequent
to its establishment, in July, 1861, the number
of patients was from one hundred and thirty
to one hundred and fifty, the average cost-
price of the ration eighteen cents, and the
monthly savings from $350 to $450. The
average monthly expenditures, after the first
few months, were about the same ; the balance
due the hospital at the close of each month,
on the monthly statement of the hospital
fund, from $300 to $500.
This would correspond to a monthly saving
THE HOSPITAL STEWARD'S MANUAL. 179
of nearly $1500 in a hospital for five hundred
patients.
The same favorable results have been ob-
tained elsewhere whenever due economy and
care have been employed in the manage-
ment.
SECTION VII. OF THE CARE OF PROVISIONS AND
HOSPITAL STORES.
Hospital stores, and those parts of the ration
which are not speedily perishable, such as
coffee, sugar, beans, rice, &c. &c, should be
kept by the steward, when possible, in a store-
room, under lock and key. The store-room
should be properly shelved, and the articles
should be stored in a systematic and orderly
manner. The strictest cleanliness is necessary,
and boxes and barrels should be kept covered
to exclude dust and dirt.
Fresh meat, fresh fruit and vegetables, and
the like perishable articles should be kept in
a separate place. In all large hospitals a
pantry should be specially set aside for this
purpose, in which during the summer-time
the ice should also be kept. Where the hos-
pital is not large enough to require a separate
room or building for this purpose, a family
180 THE HOSPITAL STEWARD'S MANUAL.
refrigerator, of a size proportioned to the ne-
cessities of the case, may be. purchased, by di-
rection of the surgeon, out of the hospital
fund, and will answer the purpose excellently.
The pantry or refrigerator, like the store-room,
should be kept locked.
The hospital steward is responsible to the
surgeon for the proper care and economical
use of the provisions and hospital supplies.
This is especially enjoined in regulations,
which provide that the senior medical officer
of a hospital "will require the steward to take
due care of the hospital stores and supplies;
to enter in a book, daily, the issues to the
ward-masters, cooks, and nurses; to prepare
the provision returns, and receive and distri-
bute the rations."
The book here directed should be ruled in
accordance with the form prescribed by regu-
lations.* It should be kept in the store-room,
and each article entered at the time of issue.
The following is the form prescribed : —
* Med. Regulations, Form 6.
THE HOSPITAL STEWARDS MANUAL.
181
f1
m
Rice.
t"1
03
Sugar.
o
tsi
Tea.
Wine.
Brandy.
m
Coffee.
&c.
gP
&c.
gP
&c.
16
a
B
!>
so
w
m
182 THE HOSPITAL STEWARD'S MANUAL.
The book should be ruled so as to give a
column to each article kept on hand, and
leave a few blank columns over for extras.
Issues should be made daily, at some de-
finite and convenient hour. 'Articles needed
for the ration should be issued to the cook, or,
in a large general hospital, to the hospital
steward having charge of the kitchen. Where
there is more than one kitchen, the steward or
cook having charge of each should receive
his share separately, and each should be
charged with it separately upon the steward's
book.
Issues of hospital stores upon the extra-diet
list, or of liquors, are to be charged to the
nurse who receives them. The stewards,
cooks, and nurses receiving these articles are
responsible to the chief steward for their pro-
per use and distribution.
THE HOSPITAL STEWARD'S MANUAL. 183
CHAPTER II.
Of the Diet Table.
Under direction of the surgeon, a regular
diet table should be established in every
hospital. For convenience' sake, the diet
should be divided into three classes, — full, half,
and low, — which are to be designated in the
diet and prescription book by the letters F.,
H., and L. In prescribing daily for each patient,
the surgeon is directed in the medical regu-
lations to write, with the prescription for each,
one of these letters, to indicate which class of
diet he shall have. The steward is therefore
able, by consulting the record, to know at once
how many patients, daily, each class of diet is
to be prepared for.
To these three classes of diet must be added
the articles of extra diet, including liquors,
which must be specially ordered daily by the
surgeon for each patient requiring them.
184 THE HOSPITAL STEWARD'S MANUAL.
SECTION I. OF FULL DIET.
To establish a proper diet table for hospital
patients requiring full diet, is a problem which
still exercises the best abilities of scientific
dietitians, and the discussion of which it is
not possible to enter into in this place. The
actual problem presented to the hospital stew-
ard in this country is to utilize to the utmost
extent the articles of diet which he can obtain
from the commissary and medical purveyor,
and those which the surgeon authorizes him to
purchase with the hospital fund.
With proper care in the management of the
hospital fund, it is possible to make these sup-
plies of such a character that the diet of a
United States military hospital may readily be
made equal or superior to that of any of the
hospitals in the world.
To do this, greater care than hitherto must
be exercised in the purchases, in the arrange-
ment of the diet table, and especially in the
cooking, of our military hospitals.
There should be three meals daily.
Breakfast at six o'clock during the summer
and seven during the winter months.
THE HOSPITAL STEWARD'S MANUAL 185
Dinner at twelve o'clock during the summer
and half-past twelve in the winter months.
Supper at six.
Breakfast should consist of well-made coffee,
of reasonable strength, with milk and sugar, of
bread and butter, and of some relish, which
should vary daily.
The coffee should be made according to the
receipt hereafter given, and should have the
milk and sugar added to it in the kitchen.
One pint should be served to each patient.
Pains should be taken to have it well made
and served hot.
Half an ounce of hitter should be served to
each patient.
A slice of bread, of about six ounces' weight,
should be laid by each plate; but the patients
should not be limited to this quantity.
A dozen additional slices, of about three
ounces each, may be placed in plates, at con-
venient intervals, along the table of the mess-
room, and each one allowed to help himself
according to his appetite. This plan will be
found more economical, as well as more satis-
factory, than the plan of adopting a fixed
ration — say eight ounces — and giving it to each
patient irrespective of his appetite. In this
16*
186 THE HOSPITAL STEWARD'S MANUAL.
case, while certain patients are not satisfied,
and complain that they are stinted, the great
majority waste a portion of their share.
The relish should consist of either cold meat,
bacon, or meat stew with onions or potatoes,
salt or fresh fish, or any similar article, which
maybe directed by the surgeon to be placed upon
the diet table. Each patient should have his
share of the breakfast relish put upon his plate.
About four ounces of cold meat, eight ounces
of hash or meat stew, eight ounces of cod-
fish hash, four ounces of salt or four ounces of
fresh fish, are proper quantities for each patient.
It is advised that but a single relish be pro-
vided for the whole full diet list for any one
day, and that in the diet table for a week the
relish be different upon each day, — the prin-
ciple of the importance of variety, as well as
quantity and nutritive value, in a diet, having
been fully established in past experience.
Receipts for preparing several dishes suit-
able for breakfast relishes will be given in the
chapter on cooking.*
Dinner presents a more difficult problem,
and one which must be met by the surgeon in
* Part III. chap. iv.
THE HOSPITAL STEWARD'S MANUAL. 187
charge in accordance with the possibilities of
each hospital locality.
In a general way, it may be said that the
dinner should consist of some well-made soup,
of meat, and of vegetables. Bread in slices of
two or three ounces each should be put upon
the table, that each patient who wishes may
eat one or more slices with his soup. Beef
soup is the most generally available, as beef is
the only fresh meat at present issued by the
commissary. But mutton soup, and, in some
hospital locations, chicken soup, may be advan-
tageously substituted by drawing so much less
beef from the commissary, and purchasing the
mutton or fowls with the hospital fund.
Good vegetable soup may be made without
using any fresh meat, thus allowing the fresh
meat for the day to be baked or roasted. A
number of receipts for different forms of soup
will be found in the article on cooking.
Too much pains cannot be bestowed in see-
ing that the soup is well made, as its nutritive
value, as well as its palatability, depends to
a great extent on the mode in which it is
prepared.
About a pint and a half of soup may be
served to each patient at dinner.
188 THE HOSPITAL STEWARD'S MANUAL.
Once or twice a week a well-made stew of
meat and vegetables, such as onions and pota-
toes, may be served instead of soup.
The meat from the soup may be served for
dinner on certain designated days of the week,
but, as this meat is far inferior in nutritive
value to meat which has not been thus used,
it is a grave error to depend upon it for the
daily dinner. On days on which other meat
is supplied for dinner, the meat from the soup,
when it is made of fresh meat, may be used
cold, as a breakfast relish, on the following
day, or may be made into a stew for the same
purpose, with a little salt meat to give it
flavor, and proper quantities of potatoes or
onions.
Thus, for example, soup made of fresh
meat may be served four days in the week,
vegetable soup, as pea or bean soup, made
with salt meat, on two days, and meat stew
with potatoes and onions on one day.
Roast or baked fresh meat may be served on
the same days with the vegetable soup. The
meat from the soup may be used on two days
at dinner ; on two days it may be used cold,
or stewed for next day's breakfast, and its
place taken at dinner by salt meat, baked or
THE HOSPITAL STEWARD'S MANUAL. 189
broiled. Fried meat should be avoided as
much as possible.
The day meat stew is substituted for soup,
some plain pudding should be served.
The quantities of these several articles of
diet which should be allowed to each patient
may be stated as follows : —
Roast or baked meat, or of boiled meat from
the soup, 8 oz. Baked, boiled, or broiled salt
meat, 6 oz. Meat stew with onions or potatoes,
1 pint. Pudding, 6 oz.
Potatoes, boiled or roasted, should be served
three or four times a week; other vegetables,
as turnips boiled, or baked beans, cabbage
boiled or raw (cold-slaugh), spinach, sour-krout,
&c, on other days. The quantity should be
for each patient at each meal about eight
ounces of potatoes or of other vegetables.
It is believed by the author of this work
that a pint of some mild malt liquor might ad-
vantageously, and without too great expense,
be added to the dinner of a general hospital in
most localities. To do this, however, the malt
liquor (ale, or lager-bier) should be purchased
by the cask or casks, and drawn as needed,
bottled malt liquors being much more expen-
sive, without being better. This is, however,
190 THE HOSPITAL STEWARD'S MANUAL.
a subject which must be determined in every
general hospital by the state of the hospital
fund and the views of the surgeon in charge.
Supper should consist of well-made tea, not
too strong, served, like the coffee at breakfast,
with milk and sugar : one pint should be
allowed to each patient, with bread and butter
in the same quantity as directed for break-
fast.
To this may be added, occasionally, well-
stewed dried fruit, or the bread and butter
may be substituted by a proper allowance of
mush and molasses, or mush and milk, — mush
one pint, with one pint of milk to each patient,
or molasses at the rate of about one gallon to
the hundred men, allowing each to help him-
self according to his taste.
SECTION II. OF HALF-DIET.
Half-diet is intended for those patients whose
condition is such as to require a smaller quan-
tity of nutriment than is afforded by the full
diet. The articles entering into its composi-
tion, and the quantities of each in any case,
will be directed by the surgeon in charge. It
should approximate the following conditions : —
THE HOSPITAL STEWARD'S MANUAL. 191
Breakfast. — Tea, with milk and sugar, about
one pint; bread, not to exceed six ounces;
butter, half an ounce.
Dinner. — Similar to full diet, but the quan-
tities smaller, say —
Soup, .... 1 pint.
Meat, . . . . 6 oz.
Potatoes, or other vegetables, 6 oz.
Supper. — Tea, bread and butter, as for break-
fast. Mush and milk, or molasses, may occa-
sionally be substituted for the bread and
butter.
SECTION" III. OF LOW DIET.
Low diet is intended for patients requiring
still less nutriment, and for whom the soup,
meat, and vegetables furnished those on full
or half diet would be too difficult of digestion.
The precise composition of the low diet of
any hospital will be directed by the surgeon in
charge. Some such scale as the following
should be approximated : —
Breakfast. — Tea and toast, with or without
some form of water-gruel, as directed by the
surgeon for individual cases. Say, tea, I pint ;
bread, toasted, 5 oz., or 3 oz. if gruel is furnished;
gruel (oatmeal or other), 1 pint.
192 THE HOSPITAL STEWARD'S MANUAL.
Dinner. — Mutton, beef, or chicken broth, 1
pint, with arrow-root, panada, farina, corn-
starch, rice pudding, or some similar article.
Supper. — The same as breakfast.
SECTION IV. OF EXTRA DIET.
Under the head of extra diet may be in-
cluded extras ordered by the surgeon for
patients put upon either of the above diet
scales, and those special cases in which, for a
particular purpose, a diet entirely unlike either
of them is directed.
Extras are most generally ordered for pa-
tients whose condition is such that they are
put upon low diet. They include eggs, poached,
boiled, beaten raw, or otherwise prepared;
oysters, raw or cooked ; chickens ; fresh fruit ;
custards ; jellies, or any similar articles which
may be directed by the surgeon. Under this
head also may be included malt liquors, wines,
and distilled liquors. Liquors may very fre-
quently be advantageously ordered as extras
to patients upon half, or even upon full, diet.
In certain cases, however, none of these
forms of diet are adapted to the case. Thus,
in certain fever cases the diet may be ordered
to consist entirely of beef essence, or beef tea,
THE HOSPITAL STEWARD'S MANUAL. 193
with wine whey, or milk punch, given at stated
intervals, or, as in certain wounds about the
face interfering with mastication, it may be
necessary that the whole diet should be in a
liquid form, consisting of soups, gruels, and the
like (spoon-diet). These forms of diet must
always be specially ordered by the surgeon;
and there is hence no necessity of discussing
them in detail in this place. A number of re-
ceipts for preparing extras of various kinds
will be found in the article on cooking.
SECTION V. SPECIMEN OF DIET-TABLE.
The following diet table is presented as a
specimen of what may be effected by reason-
able care on the part of the hospital steward
when his efforts are directed by a surgeon
aware of the resources of the service. It is the
diet table actually adopted and carried out in
the Seminary Hospital, Georgetown, D.C.,
under the care of Assistant Surgeon (now
Surgeon) J. R. Smith, U.S.A.
The same diet table, with some trifling modi-
fications, has been adopted in the Judiciary
Square Hospital (for 250 patients), under di-
rection of Assistant Surgeon (now Medical
Inspector) E. P. Vollum, U.S.A.
17
194 THE HOSPITAL STEWARD'S MANUAL.
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THE HOSPITAL STEWARD'S MANUAL. 195
Another form of diet table is that adopted
in the general hospital in West Philadelphia,
by Surgeon I. I. Hayes, U.S.V.
In this form the several articles which may
be had for each meal are printed. Each day
the surgeon in charge fills up the diet table
for the next day, indicating the articles to be
used for each meal by drawing a line through
those not selected, and writing opposite each
article the number of rations to be issued, and
the quantity in bulk of the materials to be
employed. The form is sufficiently comprehen-
sive to explain itself. It is especially adapted
to large hospitals, such as that in West Phila-
delphia, which is intended for over 2000 pa-
tients.
196 THE HOSPITAL STEWARD'S MANUAL.
jD'te^ Table of United States Army
General
FULL DIET.
Quan-
tity
in
HALF DIET.
Quan-
tity
in
No. of Rations.
bulk.
No. of Rations.
bulk.
Fresh Beef,
Bread or Toast,
Pork,
Milk,
Ham,
Sugar,
Mutton,
Tea,
<
Butter,
Butter,
Milk,
<
Bread,
Coffee,
W
Sugar,
Molasses,
Hash,
Soup,
Soup,
Fresh Beef,
Vegetables,
Corned Beef,
Hominy,
Pork,
Rice,
Mutton,
Mush,
pi
Beans,
Pudding,
Potatoes,
Bread,
Vegetables,
H
P
Hominy,
Rice,
Mush,
Pudding,
Bread,
Mustard,
Fresh Beef,
Bread,
Bread,
Butter,
Mush,
Cheese,
ti
Milk,
Mush,
3
Ph
Butter,
Milk,
Cheese,
Sugar,
P
OS
Molasses,
Sauce,
Sugar,
Molasses,
Sauce,
Tea,
Tea,
THE HOSPITAL STEWARDS MANUAL.
197
Hospital, West Philadelphia, Pa., for
186—.
LOW DIET.
No. of Rations.
Bread, half,
Gruel,
Barley Water,
Tea,
Sugar,
Milk,
Bread,
Butter,
Rice,
Arrow-Root,
Gruel,
Barley Water,
Cocoa,
Tea,
Sugar,
Milk,
Gruel,
Arrow-Root,
Rice Water,
Tea,
Sugar,
Milk,
Quan-
tity
in
bulk.
EXTRA DIET.
No. of Rations.
No. of
each
Mutton Broth,
Beef Essence,
Eggs,
Butter,
Milk,
Tea,
Sugar,
Mutton,
Chickens,
Oysters,
Pudding,
Crackers,
Butter,
Sugar,
Tea,
Wine "Whey,
Milk Punch,
Porter,
Cocoa,
Tea,
Quan-
tity
in
bulk.
17*
198
THE HOSPITAL STEWARDS MANUAL.
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THE HOSPITAL STEWARD'S MANUAL. 199
It is believed that in all general and post
hospitals, except those on the western frontier,
a scale of diet similar and equal to that above
discussed may be maintained. For frontier
posts, however, no absolute rules can be laid
down. The surgeon of the post soon becomes
familiar with the resources of the locality, and,
having done so, the best diet scale should
be adopted which the possibilities of the case
will admit of. All possible gradations will be
found, from posts at which fresh vegetables
and fresh meat of all kinds can be obtained at
prices so low that the hospital fund can pro-
cure all the surgeon may desire, with even
greater facility than in or near great cities,
to posts at which it is almost impossible to
procure any provisions except commissary
stores and hospital stores, and in which, conse-
quently, the diet can be made very little better
than it should be in the regimental hospitals
of troops engaged in an actual campaign.
The possibilities of the diet table in the field
hospitals of regiments or detachments engaged
in marches or campaigns are, of course, much
more limited than in the case of general or
post hospitals. Where troops are camped for
a considerable length of time in the neighbor-
200 THE HOSPITAL STEWARD'S MANUAL.
hood of great cities, as happened, for example,
to the army of the Potomac during the fall and
winter of 1861-62, it is possible and desirable
to create a hospital fund, and purchase milk,
butter, eggs, fresh vegetables, and other articles
of diet for the use of such patients as the sur-
geon desires to treat in the camp hospital.
Where, however, the troops are engaged in
marches and the labors of active campaigns,
this will generally be found impracticable, and
the steward will usually be directed by the
surgeon to draw the full ration, and to utilize
it and such hospital stores as are furnished by
the medical purveyor for field service to the
utmost extent.
The problem presented to the steward in
these cases is a much more difficult one than
in the case of post or general hospitals, and
one in which he muf! constantly call upon the
surgeon for advice. The following principles
may, however, be laid down for his guidance :
Wherever regular cooking is possible, and
the full ration can be drawn, an attempt
should be made to comply with the following
diet table, or with some similar table prepared
for the steward by tL^ surgeon :—
THE HOSPITAL STEWARD'S MANUAL. 201
SECTION" VI. — DIET TABLE FOR FIELD HOSPITALS.
Full diet table for a field hospital, where the hos-
pital is wholly dependent on the Commissary
and the " hospital stores."
Breakfast. — Tea or coffee, 1 pint, with
sugar, but without milk. Soft bread, 8 oz. if
furnished, or 6 oz. of hard bread, which may
be served dry, or prepared by soaking and
stewing.
Dinner. — Soup, made of fresh meat, if it is sup-
plied ; if not, of salt meat. Beans or peas may
be used in making the soup, or a very excellent
and palatable soup may be made of the desic-
cated vegetables which form a part of the ration.
(See receipts.) The meat to be served with the
soup. Where fresh potatoes are issued, meat stew
may be occasionally served instead of the soup
and meat, or the soup may be omitted, and
the meat roasted or broiled.
Supper. — The same as breakfast.
Half-diet. — The same as full diet, but with a
smaller allowance of soup and meat.
Low diet. — Breakfast and supper, the same ;
meat broth for dinner, or, instead, arrow-root,
farina, or boiled rice.
202 THE HOSPITAL STEWARD'S MANUAL.
Where the condition of the patient is such
as to require other diet, or extras, he should
be sent to the general hospital at the base of
operations. When, from the nature of the
service, it is not possible to cook regularly, or
to draw the full ration, it is best not to attempt
to treat in the field those who are sick enough
to enter hospital at all, but to send them at
once to the general hospitals in the rear.
Directions for cooking in the field will be
given in the next chapter (Section III.) .
THE HOSPITAL STEWARD'S MANUAL. 203
CHAPTER III.
Of the Kitchen and its Management.
SECTION I. GENERAL MANAGEMENT OF THE
KITCHEN.
The kitchen, like every other part of the
general hospital, is under the orders of the
chief steward, who is responsible to the sur-
geon for its proper management. The chief
cook is, in like manner, responsible to the
steward.
It is usual in a large hospital to assign one
hospital steward to the exclusive duty of super-
intending the kitchen. Where this is the case,
he is responsible to the chief steward, in the
same manner as the cook.
The cooks are hospital attendants, either
enlisted men or civilians employed as men-
tioned in Part I.
According to regulations., one cook is allowed
to every thirty patients, which would give ten to
a hospital of three hundred men. This num-
204 THE HOSPITAL STEWARD'S MANUAL.
ber will generally be found more than sufficient
for the exigencies of the service.
One of the cooks should be selected by the
surgeon as chief cook, and should have charge
of the management of all the business of the
kitchen. Where a steward is put in charge of
the kitchen, the chief cook is responsible to this
steward ; but where no steward is specially
assigned to the kitchen, the chief cook is imme-
diately responsible to the chief steward of the
hospital.
It is the business of the steward assigned to
the charge of the kitchen of a general hospital,
or of the chief cook, where no steward is assigned
to the kitchen, to receive from the chief steward
the rations and purchases for the diet of each
day: he should receive from him, at the same
time, the number of full diets, the number of low
diets, and the number and kind of extras to be
prepared for the day. He should assign the seve-
ral cooks each to some particular duty, for the
execution of which they are to be responsible.
He should see that order and discipline are
maintained in the kitchen, and that each
executes the tasks assigned to him. He should
have the receipts adopted in the hospital for
soup, for stews, &c, neatly copied upon cards
THE HOSPITAL STEWARD'S MANUAL. 205
and hung up in some convenient place in the
kitchen for the information of those whose
duty it is to prepare them. These receipts
should only be adopted after due consultation
with the surgeon in charge of the hospital, but
once selected should be rigidly adhered to.
He should also exercise supervision over the
fires, see that they are properly managed, and
that no unnecessary waste of fuel occurs.
The kitchen of a general hospital should
always be kept perfectly clean and in strict
order. Besides the range or stoves, it should
have in it one or more large tables for the pre-
paration of articles of diet. Upon the walls
should be a sufficient number of shelves to re-
ceive the kitchen-utensils, those of each kind
having their special places assigned to them, in
which they should always be found, except
when in use. Order, always indispensable in
a kitchen, is especially necessary in that of a
large establishment.
The steward or chief cook in charge of the
kitchen is responsible that the meals are in
readiness at the hours assigned for each, as
well as for their quality. The greatest punc-
tuality is demanded on this head. It is also
his duty to supervise the distribution of the
18
206 THE HOSPITAL STEWARD'S MANUAL.
food from the kitchen. This is effected in
various modes, in accordance with the plan of
the hospital, which varies in different locations.
Thus, where a general hospital has a single
large dining-room for convalescents on full diet,
the chief cook issues to the attendants detailed
to attend the dining-room the full quantity of
coffee, of soup, of bread, &c. prepared for the
number of patients allowed by the surgeon to
dine at this table. This is carried in bulk to
the dining-hall, and there distributed, under
the supervision of a responsible attendant, to
the several places, before the patients are
allowed to enter the room. Where, however,
the hospital consists of a number of detached
pavilions, each with its own dining-room, he
issues to the attendants sent from each, the
cooked rations to which the number of patients
dining in each are entitled, to be distributed in
the same manner.
The diet for patients confined to their beds
is distributed on the same general principles.
The several articles are issued in bulk to the
chief nurse of each ward, or attendants detailed
for the purpose, the quantity to be determined
by the number of patients allowed each article
of diet.
THE HOSPITAL STEWARD'S MANUAL. 207
Thus, if in a given ward ten patients are
allowed soup according to the full diet table,
the steward of the kitchen, or the chief cook,
issues fifteen pints of soup to the nurse, who
carries it in a suitable vessel to the ward, where
it is divided by measure, each patient receiv-
ing in the tin cup or soup-dish used for the
purpose the quantity allowed him; and so with
other articles.
Strict order should be maintained in these
issues, and the most careful supervision em-
ployed to see that each patient receives his
share.
Meat should be divided into rations, and
bread cut into slices, before leaving the kitchen.
On no account should patients be allowed to
come in person to the kitchen for their rations ;
nor should they be allowed to visit in the
kitchen, where it should invariably be the rule
to admit none except those whose business de-
mands their presence.
Whenever it is practicable, it is advisable to
have a separate kitchen for the preparation of
extras. This kitchen, where female nurses are
employed, may generally be put with advan-
tage under the supervision of a competent
woman assigned by the surgeon for this duty.
208 THE HOSPITAL STEWARD'S MANUAL.
All remarks as to order, punctuality, and
cleanliness applied to the general kitchen
apply here with equal force.
Cleanliness is indispensable in the kitchen.
The floors should be kept dry and well cleaned.
The tables should present the strictest pro-
priety, and the utensils should be clean and in
good condition. Slops should be received in
a large vessel — say a half-hogshead — outside
of the kitchen, which should be emptied daily
in summer-time, and at least twice a week in
winter. Where it is possible to sell these
slops, as for feeding pigs, &c, the steward
should do so, and use the proceeds as hospital
fund.
A few remarks on the mode of maintain-
ing the cleanliness of utensils will not be
amiss.
Iron utensils are very generally used for
cooking meats. The boilers for soup, the fry-
ing-pans, stew-pans, &c, are often of this
material. They should be cleaned imme-
diately after using, and before they are put
away for the day. Soap or ley should be used
to remove the grease, after which they should
be carefully dried, as very little moisture will
cause them to rust in a short time.
THE HOSPITAL STEWARD'S MANUAL. 209
Before using, they should be carefully in-
spected to see that they are clean, and be
rinsed out with a little scalding water. Fine
sand may be used with advantage to scour
these utensils, especially when they have been
rusted.
Iron vessels are sometimes tinned on the
interior, and sometimes lined with porcelain.
These surfaces will require the same care as in
the case of vessels wholly made of these ma-
terials respectively.
Copper vessels should never be used in cook-
ing, unless well lined with tin. The lining
should be carefully inspected, and renewed
whenever the copper begins to show. Grease
is to be removed by soap or ley. The copper,
as well as the tin lining, may be polished with
the finest sand, or with fine brick-dust.
Tin vessels of every kind, after having been
cleansed of all grease, may be polished with
fine sand or with whiting. Warm water should
be used in cleansing tins.
Wooden utensils are also to be kept neat by
scouring with the finest sand.
The knives, forks, spoons, plates, cups,
and other table-utensils should be thoroughly
cleansed and put away after each meal; cook-
is*
210 THE HOSPITAL STEWARD'S MANUAL.
ing-utensils, after each time of using. The
strictest cleanliness is necessary, and too great
care cannot be used to attain this end.
SECTION II. — OF FIRES AND FUEL IN GENERAL AND
POST HOSPITALS.
A good "range" heated with coal is unques-
tionably the best means of cooking for a
general hospital, where it is possible to obtain
it. Where it is supplied, there is no reason
why the best results as to the cuisine should
not be attained.
One or more properly constructed cooking-
stoves answer nearly the same purpose : they
are somewhat inferior in convenience and eco-
nomy, but, on the whole, an excellent sub-
stitute where a range cannot be had.
These cooking-stoves may be made to burn
either wood or coal. They should be so con-
structed as to give ovens for baking as well as
conveniences for boiling, and cooking over an
open fire.
Whether ranges or stoves be employed, the
cooking-utensils, such as caldrons for soup,
coffee, baking-pans, &c, should be procured
with them, to secure their being properly con-
THE HOSPITAL STEWARD'S MANUAL. 211
structed, as to form and size, to suit the amount
of fire in each case.
These utensils should be — large iron caldrons
for boiling soup or meat, holding from ten to
twenty gallons, large block-tin boilers for
coffee and tea, with a faucet about two inches
from the bottom, and holding about the same
quantities, with stew-pans, gridirons, &c. &c.
Too much care cannot be exercised in the
management of the fires. The success of the
cooking is to a great extent dependent upon it.
Thus, in the preparation of soups, a slow,
moderate fire, steadily kept up, is indispen-
sable ; while for roasting or baking, a brisk, hot
fire is equally necessary. The management
of the several varieties of ranges and stoves is
best acquired by practice and 'by steady en-
deavors to maintain the degree of heat neces-
sary for the cooking actually going on. No
general rules can, therefore, be laid down in
the brief space of this volume, and much must
depend in every case upon the discretion of the
cook, over whom the steward must keep up
a proper superintendence, never forgetting
that, while the cooks are responsible to him,
he is responsible to the surgeon, for the con
212 THE HOSPITAL STEWARD'S MANUAL.
dition of the kitchen and the quality of the
cooking.
Fuel for the hospital, whether wood or
coal, is to be obtained of the quartermaster,
on a requisition signed by the surgeon and
approved by the commanding officer.
The following form is that directed in re-
gulations : — *
* Eevised Reg., Quartermaster's Depart., Form No. 30, p. 208.
THE HOSPITAL STEWARD'S MANUAL. 213
FORM OF REQUISITION FOR FUEL.
Requisition for Fuel for the Hospital at , for the
month of , 186
WOOD.
COAL.
REMARKS.
Cord.
Feet.
Inches.
Bushels.
Pounds.
Number
of fires.
Total...
I certify, on honor, that the above requisition is correct and
just, and that I have not drawn fuel for any part of the time
above charged.
Surgeon U.S.A.
Received at , the of 186 ,
of , Assistant Quartermaster U.S.A.,
cords feet inches of wood
and of coal, in full of the above
requisition.
Surgeon U.S.A.
(Copies of this requisition should be kept on file by the Steward.)
214 THE HOSPITAL STEWARD'S MANUAL.
Fuel is to be drawn monthly. It should be
kept in a place appropriated to the purpose,
convenient to the kitchen. If wood, it should
be neatly piled after having been cut or sawed
into lengths such as needed for use. If coal, it
should be kept under cover, as it deteriorates
from exposure.
SECTION III. FIRES AND FUEL IN CAMP-HOSPITALS.
The best cooking apparatus in the camp-
h ospital is a good camp cooking-stove. Very fre-
quently, however, this is not attainable. The
hospital steward is then obliged to resort to
other means, which are more or less imper-
fect. The plan generally resorted to is
that usually employed by our soldiers in the
field. It is very simple. A trench eighteen
inches wide, and nine or ten deep, is cut of a
length which varies in accordance with the
amount of cooking to be done. A forked stake
is driven into the ground at each end of the
trench, and a pole laid across in the forks.
From this pole the kettles for boiling soup,
coffee, &c. are suspended. Pieces of meat for
roasting may be suspended by strings. Pans
for stewing are placed over the fire, supported
THE HOSPITAL STEWARD'S MANUAL. 215
upon properly placed stones, or, in locations
where — as often happens in this country — these
cannot be obtained, upon sods cut about twelve
inches square, and properly piled on each side
of the trench for this purpose.
The figure illustrates the plan.
Where it is possible to line the trench with
brick and build a chimney at one end, it will
be found an improvement ; but even then the
plan is a very imperfect one. (See figure).
The objection to these plans is that changes
in the direction of the wind interfere con-
stantly with the steadiness of the fire.
216 THE HOSPITAL STEWARD'S MANUAL.
To obviate this difficulty is the great prac-
tical question in building extemporaneous field-
fires. The plan of the Turkish soldiers in the
Russian war is commended by Miss Nightin-
gale as attaining this end :* —
" The Turkish soldier cuts a trench, six
inches deep and six wide, in a curve against a
bank, natural or artifical, not less than two
feet high. He cuts a few trenches of like size
in the earth, radiating inward from the curvi-
linear trench : he places his kettles upon the
intersection of these trenches, and the result
is a steady draught leading upward against the
bank ; no blast of air blows through any one
trench so as to disturb the fire."
I have never seen this plan tried; but it is
simple, rational, and appears likely to attain
the desired objects.
Another plan, and well adapted to a clayey
soil, is that adopted by the salt-boilers of New
York. A hole three feet square and two deep
is dug in the slope of a hill. From this a shaft
is run laterally about one foot square and six
long : at the extreme end of this a shaft is sunk
* Notes on Matters Affecting the Health, Efficiency, and Hos-
pital Administration of the British Army. By Florence Nightin-
gale. London, 1858. Printed for private distribution ; pp. 402.
THE HOSPITAL STEWARD'S MANUAL. 217
vertically, and a chimney built : three holes, of
such diameter that the camp-kettles will not
sink through, are pierced at equal distances
along the horizontal shaft. The fire is built
in the square hole, the draught is borne through
the lateral shaft to the chimney. The kettles
for coffee, soup, &c. are set over the holes; the
immediate fire may be used for roasting and
boiling. (See figure on p. 218).
The accompanying illustrative diagram is
from the little pamphlet by Capt. J. M. Sander-
son, C. S. of volunteers, on "camp-fires and
camp-cooking," which was recently distributed
from the Commissary-General's office.
Lastly, very satisfactory cooking on a small
scale may be done over fires arranged as de-
scribed in the remarks on warming hospital
tents.*
Fuel for camp-hospitals is either obtained,
as in barracks, by requisition on the quar-
termaster, or by cutting wood in neighbor-
ing forests, or collecting it from whatever
source may offer in individual cases. The
duty of collecting it belongs to the police of
* See Part II. chap. ii. sect. iii.
19
218 THE HOSPITAL STEWARD'S MANUAL.
Outside View.
the regiment or brigade to which the hospital
belongs, who, while collecting wood for the
general cooking of the command, collects it also
for the hospital. The order for this purpose is
given by the commanding officer, at the re-
quest of the surgeon.
THE HOSPITAL STEWARD'S MANUAL. 219
CHAPTER IV.
Cooking in Hospitals.
SECTION I.— GENERAL REMARKS.
Perhaps no subject is more worthy of atten-
tion in a hospital than the quality of the food
and the character of the cooking. In the
latter there is certainly greater room for im-
provement in United States army hospitals
than in the former. The rations furnished by
the commissary department are generally of
good quality and in good condition; the articles
purchased with the hospital fund ought cer-
tainly to be of good quality; but, however
good the raw articles may be, bad cooking will
impair their nutritive value, as well as the
relish with which they are eaten by the pa-
tients.
Cooking serves for two distinct purposes.
In the first place, it serves so to modify the
food by the heat employed as to cause it to be
more readily dissolved during digestion. But
in the second place, also, it serves, by rendering
220 THE HOSPITAL STEWARD'S MANUAL.
the food more palatable, to incite the digestive
secretions, and thus not only to increase the
appetite, but also the energy of digestion.
Now, on the one hand, the heat may be
erroneously so employed as to have the effect
rather of rendering articles of food insoluble,
and therefore difficult of digestion, or of pro-
ducing destructive changes, as where the food
is more or less burned ; and, on the other hand,
the food may be so cooked as to be unpalat-
able, which will have the effect not merely of
diminishing the appetite and causing the pa-
tient to eat less food than he should, but
impairs directly his digestive energies, so that
he does not digest what he does eat, as well as
he would have done had it been properly pre-
pared.
As an illustration of the erroneous manage-
ment of heat, may be cited the preparation
of soups, in which, if a brisk ebullition be kept
up from the first, the exterior of the pieces of
meat is rapidly hardened, and the full strength
is never taken up into the soup as it is where
the water put in cold is gradually brought
nearly, but not quite, to the boiling-point, and
allowed to simmer for several hours.
In other cases a hot fire is required, as in
THE HOSPITAL STEWARD'S MANUAL. 221
roasting, where if the fire is brisk the outside
of the piece rapidly becomes crisp, and all the
juices are kept in, while if the fire is slow the
juices leak gradually away, and the meat is
left tasteless and insipid.
With the hope of contributing somewhat to
the improvement of the cooking in the hos-
pitals of the United States army, a number of
receipts for ordinary and extra diet are here
given. Most of these receipts are those of the
celebrated M. Soyer, and have not only been
thoroughly tested during the Crimean War, but
have most of them received an approval, based
upon actual experience, by United States army
surgeons.
The use of these or similar receipts will
insure the palatability and proper preparation
of the food. As to its palatability, the steward
may adopt a very simple rule. The food must
be regarded as deficient in this respect unless
it gives satisfaction to the patients. Of course,
there are some grumblers who will find fault
under all circumstances; but where the cook-
ing is generally complained of, it must be bad,
and the steward should at once consult with
the cooks, and, if necessary, with the surgeon,
as to the means of improving it.
19®
222 THE HOSPITAL STEWARD'S MANUAL.
SECTION II. RECEIPTS ADAPTED TO THE ORDINARY
DIET IN HOSPITALS.
No. 1. Coffee for ten men. — {Soyer's method.)*
— Put 9 pints of water into a canteen, sauce-
pan (or other vessel) on the fire ; when boil-
ing, add lh oz. of coffee; mix them well
together with a spoon or piece of wood ; leave
on the fire a few minutes longer, or until just
beginning to boil. Take it off, and pour in
1 pint of cold water; let the whole remain ten
minutes, or a little longer; the dregs will fall
to the bottom, and the coffee will be clear.
Pour it from one vessel into another, leaving
the dregs at the bottom; add 2 teaspoonfuls
of sugar to the pint. If milk is to be had,
make 2 pints less of coffee, and add that much
milk ; boiled milk is preferable.
Remarks. — This receipt, properly carried
out, would give 10 pints of coffee, or 1 pint per
man. The allowance of coffee in the army
ration is 1 lb. to ten men.
* Most of the following receipts are taken, with little or no
alteration, from " Soyer's Culinary Campaign." By Alexis
Soyer. London, 1857.
THE HOSPITAL STEWARD'S MANUAL. 223
This quantity would give 8 oz. to 10 pints
of coffee for breakfast, and the same for sup-
per, or a little more than M. So3^er's allowance.
If tea is used for supper, only half the ration
of coffee should be drawn, and tea drawn for
the rest. To calculate the quantity of coffee
to be drawn upon the provision return in a
hospital where coffee is used for breakfast
only, the following rule may be given. Divide
the number of patients and attendants allowed to
use coffee by two: the result is the number of
rations of coffee required per day.
In great hospitals the coffee is usually made
in large caldrons or boilers, holding each enough
for fifty or one hundred men.
The following modified receipt may be used : —
No. 2. Hospital receipt for coffee for fifty men.
allowing 1 pint to each. — Ingredients needed. —
Water, 5 gallons, milk, li gallon, sugar, 3 s lbs.
Directions. — Put into the boiler 35 pints of
water (4 gallons and 3 pints) ; bring it to
a boil. When boiling, add 2 J lbs. of coffee;
stir well until ebullition has thoroughly recom-
menced, say for four or five minutes; then
lift the boiler off the fire, and pour in 5 pints
(2 i quarts) of cold water. Let it stand about
224 THE HOSPITAL STEWARD'S MANUAL.
ten minutes, when the coffee may be care-
fully poured or drawn off into the coffee-pots,
leaving the dregs behind. To every two quarts
drawn off add a pint of milk (boiled milk is
best) and 3 oz. of sugar. A seven or eight gallon
coffee-boiler answers very well for this pur-
pose. If coffee for a hundred men is to be
cooked in a single vessel, use double the
quantity.
Remarks. — Two points in these receipts are
of practical importance. First, the coffee is
not to be introduced until the water is boiling,
nor is it to be boiled too long. If this is
neglected, the aroma is destroyed, and the coffee
is muddy and insipid. Secondly, the subse-
quent addition of cold water causes the dregs
to subside more rapidly, and " dears'' the coffee.
No. 3. Tea for eighty men. — {M. Soyers re-
ceipt.)— Put 40 quarts of water in a boiler to
boil; place the rations of tea in a fine net very
loose, or in a large perforated ball; give one
minute to boil; take out the fire, if too much;
shut down the cover : in ten minutes it is ready
for use.
THE HOSPITAL STEWARD'S MANUAL. 225
No. 4. Tea for fifty men. — [Hospital Receipt
based on Soger's Receipt.) — Ingredients needed. —
20 quarts of water, 5 of milk, 6 oz. of tea, and
34 -pounds of sugar. Directions. — Put into the
boiler 20 quarts of water, 2 J gallons. Bring it
to a boil. When boiling, introduce 6 oz. of tea
tied up loosely in a bag of bobinet or mosquito
netting, to prevent the leaves becoming diffused
throughout the liquor. Allow it to boil one or
two minutes ; then lift the boiler off the fire,
and allow it to stand on the stove or range,
but not over the coals, for ten or fifteen minutes
to draw. While drawing, the boiler should be
covered. Stir in now 5 quarts of milk and 34
pounds of sugar, and the tea is ready for the
table.
Remarks. — The aim of this process is not to
boil the tea, but to allow it to macerate (or
draw) in boiling water.
No. 5. Codfish Hash. — Put the salt fish to
soak over night in lukewarm water, fleshy
side downward. Next morning put it in a pot
with fresh water, and simmer till it is tender.
Pick the flesh from the skin, rejecting the
bones ; chop it fine, and mix with three times
226 THE HOSPITAL STEWARD'S MA*NUAL.
its weight of boiled potatoes, moistening the
mixture with pork scraps and dip (i.e. pork
cut up fine and tried out). The addition of
some milk will be found a great improvement.
About 12 pounds of fish and 36 of potatoes
prepared in this way will make a good break-
fast relish for one hundred men.
No. 6. Beef Soup for fifty men. — Soyer 's Army
Receipt. — Ingredients needed. — Cold water, Ih
gals., fresh beef, 50 lbs., rice, 3 lbs., fresh vege-
tables (viz. carrots, onions, turnips, potatoes,
parsley, &c.&c), 8 lbs. (or desiccated vegetables,
1 J lbs.), 10 small tablespoonfuls of salt, 1 table-
spoonful of pepper. Directions. — Put all the
ingredients, except the rice, into the boiler; gra-
dually bring it to a boil ; then add the rice, and
simmer three hours, when it will be ready to
serve. Before serving, the fat should be
skimmed off and kept in a clean vessel; it will
serve as an excellent substitute for butter for
many cooking purposes. The meat may be
eaten with the soup, or, if other meat is given
at dinner, may be kept for breakfast relishes.
Remarks. — This soup, which is given by M.
Soyer among his army receipts, is perhaps in-
ferior, on the whole, to the next receipt.
THE HOSPITAL STEWARD'S MANUAL. 227
No. 7. Semi-stewed Beef and Soup for one
hundred men. — (Soyers Hospital Receipt.) — In-
gredients needed. — Cold water, 130 pints (16i
gallons), fresh beef, 70 lbs. (in pieces of 4 or
5 lbs.), mixed fresh vegetables, 12 lbs. (carrots,
onions, parsley, turnips, potatoes, &c, according
to taste or convenience), barley, or rice, 9 lbs.
6 oz., salt, 1 lb. 7'oz., flour 1 lb. 4 oz., sugar,
1 lb. 4 oz., pepper, 1 oz. Directions. — Put all
the ingredients into the caldron at once, ex-
cept the flour; set it on the fire, and, when
beginning to boil, diminish the heat and simmer
gently for two hours and a half; then add to
the soup the flour, which has been first mixed
with enough water to form a light batter ; stir
well together with a large spoon; boil another
half-hour; skim off the fat; take out the meat,
and serve the soup and meat separate. The
soup should be stirred now and then while
making, to prevent burning, or sticking to the
sides of the caldron.
Remarks. — The joints are cooked whole, and
afterwards cut up into equal portions, one for
each man. The meat cooked in this way is
more nutritious. Where fresh vegetables can-
228 THE HOSPITAL STEWARD'S MANUAL.
not be obtained, 3 lbs. of mixed desiccated
vegetables may be substituted for 12 of fresh.
Variations. — The addition of a quarter of a
pound of curry powder, or of half a pint of
burnt-sugar water, gives an agreeable diversity
in appearance and flavor.
No. 8. Semi-stewed Mutton and Soup for one
hundred men. — (Soyers Hospital Receipt.) — In-
gredients.— The same as in the last receipt,
except that mutton is substituted for beef.
Proceed the same as for beef, except that, as
mutton needs less cooking than beef, the joints
should be taken out before the flour is added,
and kept warm in a suitable pan till time for
serving.
No. 9. Plain Irish Stew for fifty men. —
{Soyers Receipt?) — Ingredients. — Fresh mutton
or beef, 50 lbs., large onions, 8 lbs., whole po-
tatoes, 12 lbs., 8 tablespoonfuls of salt, 3 table-
spoonfuls of pepper ; water, a sufficient quan-
tity. Directions. — Cut the meat into pieces of
a quarter of a pound each ; put the ingredients
into the pan with enough water to cover them
all. Set it on the fire, and keep up gentle
ebullition, stirring occasionally, for an hour
THE HOSPITAL STEWARD'S MANUAL. 229
and a half for mutton, and two hours for beef.
Then mash some of the potatoes to thicken
the gravy, and serve.
Variations. — Fresh veal, or pork, may be
used instead, when convenient.
No. 10. " Soyers Food" for fifty men. — Ingre-
dients.— Fresh beef, 50 lbs., onions, 7 lbs., flour,
11 lbs., 10 tablespoonfuls of salt, 2 tablespoon-
fuls of pepper, 4 tablespoonfuls of sugar, water,
18 quarts. Directions. — Cut the beef into pieces
of a quarter of a pound each, slice the onions,
and introduce all the solid ingredients except the
flour, with a little of the water, into the boiler.
Set it on the fire and let it stew, stirring oc-
casionally, for twenty to thirty minutes, or till
it forms a thick gravy ; then add a pound and
a half of flour 5 mix well together, and add the
rest of the water; stir well for a minute or
two ; regulate the stove to a moderate heat,
and let simmer for about two hours.
Variations. — A pound of rice may be added
to great advantage, also plain dumplings, and
potatoes, or mixed vegetables.
No. 11 . Suet Dumplings for Soups or Steios. —
(Soyers Receipt) — Ingredients. — Half a pound
20
230 THE HOSPITAL STEWARD'S MANUAL.
of flour, half a teaspoonful of salt, a quarter
of a pound of chopped fat pork (or of beef
suet), and eight tablespoonfuls of water, with
two onions chopped fine, if convenient. Direc-
tions.— Mix well into a thick paste; divide
into pieces of convenient size; roll them in
flour and put into the soup, or stew, about
half an hour before it is done.
Remarks. — A few dumplings made in this
manner, and scattered through the soup, are a
great addition, but they should not be too
abundant.
No. 12. To toil Salt Beef (or Porh) for fifty
men. — (Soyers Receipt.) — Put 50 lbs. of meat
in pieces of 3 or 4 lbs. each into a boiler; fill
the boiler with water, and let the meat soak
all night. Next morning wash the meat well,
and pour away the salt water. Fill the boiler
with fresh water; boil gently three hours, and
serve. Skim off the fat, which, when cold, is
an excellent substitute for butter.
For salt pork, proceed as above, or boil half
beef and half pork. The pieces of beef should
be smaller than those of pork, as beef requires
longer to cook. Where salt meat cannot be
THE HOSPITAL STEWARD'S MANUAL. 231
soaked all night, it should be parboiled for
twenty minutes, and then the water poured off',
fresh poured on, and the cooking commenced.
No. 13. Soup from the Liquor in which Salt
Pork has been boiled. — The liquor in which salt
pork has been boiled can be made into a very
good soup with peas, or beans. Add to the
liquor in which 50 lbs. of salt pork has been
cooked 5 lbs. split peas, I lb. brown sugar, 2
tablespoonfuls of pepper, and 10 onions; sim-
mer gently till the peas are reduced to a pulp,
and serve. Broken biscuit may be introduced.
This will make au excellent mess. Beans
properly soaked may be substituted for the
peas.
No. 14. — Stewed Salt Beef and Porh for one
hundred men. — Ingredients. — Well-soaked beef,
30 lbs. cut into pieces of \ lb. each, pork, 20 lbs.,
sugar, \\ lbs., onions, sliced, 8 lbs. water, 25
quarts, rice, 4 lbs. Directions. — Introduce all
the ingredients into a boiler; simmer gently for
three hours; skim the fat off the top, and serve.
Remarks. — The beef and pork must be well
soaked over night, according to the directions
given in Receipt No. 12.
232 THE HOSPITAL STEWARD'S MANUAL.
No. 15. Bean soup for one hundred men.
Ingredients. — 8 quarts of beans, 30 lbs. of pork,
half a dozen onions, salt, i lb., pepper, 1 oz.,
water, 120 pints (15 gallons). Directions. —
Soak the beans over night in cold water. Cut
the pork into pieces of from three to five
pounds each.
At eight o'clock in the morning the beans are
to be put into a caldron filled with water,
and boiled for two hours and a half, when the
water is to be poured off and the beans are to
be added to the pork-liquor next to be de-
scribed. The pork is to be introduced into
another caldron, at quarter-past eight o'clock,
and boiled briskly for an hour, when the liquid
is to be poured off and replaced by clean hot
water, 120 pints to 30 lbs. of pork. The pork
is now to be boiled an hour and a half longer,
when it is to be taken out and laid aside to be
served separately. The beans are then added
to the liquid in which the pork was boiled, with
the salt, pepper, and the onions (chopped or
sliced). After fifteen minutes' more boiling,
the beans are to be mashed with a wooden
spoon made for the purpose, and the soup,
which is now ready, is to be served with a
slice of pork in a separate dish.
THE HOSPITAL STEWARDS MANUAL. ZOO
No. 16. Bean Soup for one hundred men.
— [American Army Receipt.) — Ingredients. — 8
quarts of beans, 20 lbs. of pork, half a dozen
onions, salt, i lb., pejDper, 1 oz., water, 120 pints
(15 gallons) . Directions. — Soak the beans over
night. Early in the morning put them into a
caldron with the salt and water, and boil steadily
for three hours, or until the beans are so well
done that they can be strained through a sieve,
leaving their skins on the sieve. They are
then to be so strained, after which the pork,
cut in slices, the onions, chopped fine, and the
pepper, are to be added, and the boiling con-
tinued two to three hours longer, or till the
jDork is done tender, when the soup is ready.
In making this soup, good soft water is re-
quired. At posts where the water is hard,
rain-water must be substituted. The caldron
must be clean and free from grease, and grease
in every shape must be avoided until the beans
are done.
No. 17. Browning for Soups. — Put i lb. of
moist sugar into an iron pan, and melt it over
a moderate fire, stirring it continually till
quite black, which will take about twenty-five
minutes; it must color by degrees, as too sud-
20*
234 THE HOSPITAL STEWARD'S MANUAL.
den a heat will make it bitter : then add 2
quarts of water, and in ten minutes the sugar
will be dissolved. You may then bottle it for
use. It will keep good for a month, and will
always be found very useful.
No. 18. Baked Pork and Beans. — The beans
and pork, having been soaked over night, are
boiled separately in. the morning for about two
hours. The pork is then put into pans, sur-
rounded and covered by the beans, a little
pepper added, and baked one hour by a mode-
rate fire.
No. 19. Corned Beef and Cabhage. — The
beef, having been soaked in fresh water over
night, is placed in a caldron and simmered
over a moderate fire for two hours and a half,
skimming carefully every fifteen or twenty
minutes. As much cabbage as the water will
cover is then introduced, and the ebullition is
to be continued gently for an hour and a half.
No. 20. Boiled Potatoes. — Wash the potatoes,
and put them with their skins on into the
caldron: throw in a handful of salt, and fill
the vessel with cold water. Put it on the fire,
THE HOSPITAL STEWARD'S MANUAL. 235
and bring it to a boil. When the water boils,
throw in a little cold water to check it: do so
two or three times. When the potatoes are
very nearly cooked, pour off all the water, and
stand the kettle over the fire till the steam
evaporates. This process will make the po-
tatoes mealy.
No. 21. Indian Mush for one hundred men. —
[American Army Receipt.) — Ingredients. — In-
dian meal, 20 lbs., water, 70 pints (81 gallons),
salt, 6 oz. Moisten slightly the meal with
water. It will require about one gallon and
three-fourths for this purpose. Have the rest
of the water — say 7 gallons — in the caldron
boiling; add the salt, then stir in the moistened
meal. The stirring should be continued after
all the meal is in, to prevent burning. From
twenty minutes to half an hour will be found
long enough to boil. The above quantities
will make 100 pints of mush, or a little more.
One pint may be served to each man, with
molasses or milk. If milk, one pint should
be allowed to each patient; if molasses, one
gallon to one hundred men.
Kemarks. — If the meal is stirred in dry, the
mush will be lumpy.
236 THE HOSPITAL STEWARD'S MANUAL.
No. 2 2 . Plain Boiled Rice. — (Soger's Receipt?)
— Rice, I lb., water, 2 quarts, salt, 1 tea-
spoonful, or in that proportion for larger
quantities. Put the salt and water into the
stew-pan or boiler. When boiling, add the
rice, previously well washed. Boil for ten
minutes, or till each grain becomes rather soft.
Drain it on a colander. Slightly grease the pot
with butter; put the rice back into it; let it
swell slowly for about twenty minutes near
the fire or in a slow oven ; each grain will then
swell up and be well separated. It is then
ready for use.
No. 23. Bread.
When the hospital is not situated near a
Government bakery, it is desirable for it to be
able to bake its own bread. For this purpose
the " Shiraz oven" may be obtained by requi-
sition on the Chief of the Commissariat. One
of these ovens will be found ample to do the
baking for about three hundred patients. The
following receipts are copied from the little
pamphlet on Camp Fires and Camp Cookery,
by Captain J. M. Sanderson, C. S. of Volun-
teers*
* Camp Fires and Camp Cookery ; or, Culinary Hints for the
THE HOSPITAL STEWARD'S MANUAL. 237
"To make Yeast. — Fill a kettle three-fourths
full of clean, clear water ; place it over a brisk
fire, and, when it boils, add three good hand-
fuls of hops ; then put into the yeast-tub four
pounds of flour, and strain into it, from the
kettle, enough of the hot " hop-water" to make
a paste, working it until it is perfectly free
from lumps. By this time the hops in the
kettle will be sufficiently boiled, and must be
strained into the yeast-tub, and stirred with a
wooden paddle until thoroughly amalgamated.
Let it stand until it cools a little, — about blood-
heat, — and add three pints of cracked malt and
two quarts of stock yeast, mixing it all well
together to prevent any lumps remaining, and
setting it away in some quiet, warm place,
where it will remain undisturbed, for fifteen
hours; then it must be strained before using.
Care must be taken always to keep enough on
hand for stock for the next making.
" To make Bread. — The first process is to pre-
Soldiers, including Keceipts for making Bread in "the Portable
1'ield Oven" furnished by the Subsistence Department. By
Captain J. M. Sanderson, C.S. of Volunteers. Published for
distribution to the troops, Head-Quarters "Army of the Poto-
mac," January, 1862.
238 THE HOSPITAL STEWARD'S MANUAL.
pare the ferment. This is formed by boiling
thoroughly a peck and a half of potatoes, with
their skins on, which you place in a barrel
kept exclusively for that purpose, adding six
pounds of flour, and mashing them well to-
gether. This is called "scalding the flour."
Then add cold water until it is cool enough to
enable you to put your hands in, and break up
the potatoes as fine as possible, so as to obtain
all their virtue. Then add about six pailfuls
of warm water, and six quarts of yeast. Stir
it well together, and place it in a warm spot,
where it will not be disturbed. Two good-
sized tubs, made of salt or sugar barrels, would
be the best receptacle for it, as it requires
space to work in. This should be made at
night, and will be ready for use in the morning
after it is carefully strained.
"The second process is making the dough.
This is done by sifting into the trough a barrel
and a half of flour, one-third of which is pinned
or blocked up at one end by the "pin-board"
or wooden slide. To this you add three and a
half pounds of salt and three and a half pail-
fuls of "ferment," with four pailfuls of hot
water, — not so hot, however, as to scald your
ferment (in summer, cold water is used in-
THE HOSPITAL STEWARD'S MANUAL. 289
stead of hot), — and mix well together, knead-
ing thoroughly and faithfully, adding to it gra-
dually all the flour in the trough until it is of
one consistency. It must then be placed at
one end of the trough, and again pinned in by
the slide, leaving space enough, however, to
allow it to prove. To effect this requires at
least two hours, when it will be ready to
" work off," which is done by " throwing" it out
of the trough, in masses, on to the table or
cover on the other side of the room or tent.
It is then cut into pieces and weighed, or
"scaled off," and immediately moulded into
shapes or loaves. This requires one man to
scale, one to form into loaves, and a third to
"pan it away," where it remains for at least
forty minutes before placing it in the oven.
In the mean time the ovens are heated, the
coals and ashes drawn out, and the interior
thoroughly swabbed out, top and bottom. If
too hot, wet the swab and dampen the oven.
The pans containing the dough are then set in,
by means of the heel or wooden spade, the
doors closed, and the hot coals and ashes
placed against them, in order to heat all sides
equally. Fifty minutes is the time generally
240 THE HOSPITAL STEWARD'S MANUAL.
required to bake the usual-sized army loaves ;
if larger, a longer period will be required.
" The amount of ferment made in accordance
with this receipt will be sufficient for three
batches of 288 loaves each. The first batch
will require four hours in preparing and baking;
the second and third, two hours each.
" Potatoes, hops, and malt should always be
kept on hand, and a portion of the yeast in-
variably retained as stock. To commence
with, it will be necessary to obtain brewer's
yeast; but after making the first essay you
can always be independent."
SECTION III. RECEIPTS FOR EXTRA DIETS.
(Soger's Receipts.)
No. 1. Beef Tea. Receipt for 6 pints. — Cut
3 lbs. of beef into pieces the size of walnuts,
and chop up the bones, if any; put it into a
convenient-sized kettle with h lb. of mixed
vegetables, such as onions, leeks, celery, tur-
nips, carrots (or one or two of these, if all
cannot be obtained), 1 oz. of salt, a little pep-
per, 1 teaspoonful of sugar? 2 oz. of butter, and
J pint of water. Set it on a sharp fire for ten
minutes or a quarter of an hour, stirring now
and then with a spoon, till it forms a rather
THE HOSPITAL STEWARD'S MANUAL. 241
thick gravy at bottom, but not brown ; then
add 7 pints of hot or cold water, — but hot is
preferable. When boiling, let it simmer gently
for an hour; skim off all the fat, strain it
through a sieve, and serve.
No. 2. TJiich Beef Tea. — Dissolve a large tea-
spoonful of arrow-root in a gill of water, and
pour it into the beef tea above described twenty
minutes before passing through the sieve.
No. 3. Beef Tea with Calves -foot Jelly or Isin-
glass.— Add i oz. calves'-foot gelatine or isin-
glass to the above quantity of beef tea, when
cooking, previous to serving.
No. 4. Miction and Veal Tea. — Mutton and
veal will make good tea by proceeding pre-
cisely the same as above. The addition of
a small quantity of aromatic herbs is always
desirable. If no fresh vegetables are at hand,
use 2 oz. of mixed preserved vegetables to any
of the above receipts.
No. 5. Chicken Broth. — Put in a stew-pan a
fowl, 3 pints of water, 2 teaspoonfuls of rice,
1 teaspoonful of salt, a middle-sized onion, or
21
242 THE HOSPITAL STEWARD'S MANUAL.
2 oz. of mixed vegetables ; boil the whole gently
for three-quarters of an hour: if an old fowl,
simmer from one hour and a half to two hours,
adding 1 pint more water ; skim off the fat, and
serve.
Note. — A light mutton broth may be made
precisely the same, by using a pound and a half
of scrag of mutton instead of fowl.
No. 6. Beef Essence. — Cut 1 pound of lean
but tender beef in to small dice, and introduce
them into a bottle, which is to be corked and
stood in a pot of water; boil for three hours;
then strain off the liquor by putting the meat,
after all that can be is poured off, in a linen
bag and expressing. A little pepper and salt
may be added.
No. 7. Sweet Rice. — Add to i lb. of rice plain
boiled, as directed in Receipt No. 22, p. 236, 1
oz. of butter, 2 tablespoonfuls of sugar, a little
cinnamon, a quarter of a pint of milk ; stir it
with a fork, and serve. A little currant jelly or
jam may be added to the rice.
No. 8. Rice with Gravy. — Add to the same
THE HOSPITAL STEWARD'S MANUAL. 243
quantity of rice 4 tablespoonfuls of the essence
of beef, a little fresh butter, half a teaspoonful
of salt ; stir together with a fork, and serve.
No. 9. Plain Oatmeal. — Put in a pan I lb.
of oatmeal, lh oz. of sugar, half a teaspoonful
of salt, and 3 pints of water ; boil slowly for
twenty minutes, stirring continually, and serve.
A quarter of a pint of boiled milk, an ounce of
butter, and a little pounded cinnamon or spice,
added previous to serving, is a good variation.
No. 10. Calves' -Foot Jelly. — Put in a proper-
sized stew-pan 2i oz. of calves'-foot gelatine, 4
oz. of white sugar, 4 whites of eggs and shells,
the peel of a lemon, the juice of 3 middle-sized
lemons, half a pint of marsala or sherry wine.
Beat all well together with the egg-beater for
a few minutes; then add 4 J pints of cold water;
set it on a slow fire, and keep whipping it till
boiling. Set it on the corner of the stove,
partly covered with the lid, upon which you
place a few pieces of burning charcoal ; let it
simmer gently for ten minutes, and strain it
through a jelly-bag. It is then ready to be put
in ice or some cool place.
For orange jelly, use only 1 lemon and 2
244 THE HOSPITAL STEWARD'S MANUAL.
oranges. Any delicate flavor may be intro-
duced.
No. 11. Farina Pudding. — Boil 3 pints of
milk, into which, while boiling, sprinkle slowly
one-quarter of a pound of farina (Hecker's
farina). Continue the boiling three-quarters
of an hour. Turn it into a jelly-mould, and
place it on ice or in cold water to stiffen. It
may be eaten with pulverized sugar.
The boiling should be conducted in a double
boiler, or in a saucepan set into a pan of water
to boil in such a way that the bottom of the
saucepan does not touch the bottom of the pan :
this is to avoid burning.
No. 12. Corn Starch Blanc-Mange. — Beat
6 tablespoonfuls of corn starch (Duryea's
Maizena) thoroughly with 3 eggs ; add to it 1
quart of milk nearly boiling, and previously
salted a little : allow it to boil a few minutes,
stirring briskly. Flavor with lemon or vanilla,
and pour into a mould to stiffen. It may be
sweetened before cooking, or may be cooked
without sweetening, and eaten with pulverized
sugar or a sauce.
THE HOSPITAL STEWARD'S MANUAL. 245
No. 13. Boiled Custard (Com Starch). —
Heat 1 quart of milk nearly to boiling; add
2 tablespoonfuls of corn starch previously
mixed with a little milk, 3 eggs well beaten,
with 4 tablespoonfuls of powdered sugar, half
a teaspoonful of salt, and a small piece of butter.
Flavor with lemon or vanilla. Let it boil up
once or twice, stirring briskly, and it is done.
To be eaten cold.
No. 14 . Calves -Foot Jelly, from Calves' Feet. —
This jelly requires to be made the day previous
to being used, requiring to be very hard to
extract the fat.
Take 2 calves' feet, cut them up, and boil in 3
quarts of water ; as soon as it boils, remove it
to the corner of the fire and simmer for five
hours, keeping it skimmed; pass through a hair
sieve into a basin, and let it remain until quite
hard ; then remove the oil and fat, and wipe
the top dry. Place in a stew-pan § pint of
water, 1 pint of sherry, \ lb. of lump sugar,
the juice of 4 lemons, the rinds of 2, and the
whites and shells of 5 eggs; whisk until the
sugar is melted; then add the jelly, place it on
the fire, and whisk until boiling; pass it through
a jelly-bag, pouring that back again which
21*
246 THE HOSPITAL STEWARD'S MANUAL.
comes through first, until quite clear : it is then
ready for use. Vary the flavor according to
fancy.
Ox-feet or cow-heel may be used instead of
calves' feet, where these cannot be had; but
they require an hour more simmering. In
summer, ice must be used to set the jelly.
No. 15. Sago Jelly. — Put into a pan 3 oz.
of sago, II oz. of sugar, half a lemon-peel cut
very thin, i teaspoonful of ground cinnamon,
or a small stick of the same ; put to it 3 pints
of water and a little salt ; boil ten minutes, or
a little longer, stirring continually, until rather
thick; then add a little port, sherry, or marsala
wine : mix well, and serve hot or cold.
No. 16. Arrow-Root Milk. — Put into a pan
4 oz. of arrow-root, 3 oz. of sugar, the peel of
half a lemon, I teaspoonful of salt, 2 J pints of
milk; set it on the fire, stir round gently,
boil for ten minutes, and serve. If no lemons
are at hand, a little essence of any kind will do.
When short of milk, use half water : half an
ounce of fresh butter is an improvement before
serving.
THE HOSPITAL STEWARD'S MANUAL. 247
No. 17. Thick Arroio-Root Panada. — Put in
a pan 5 oz. of arrow-root, 2 £ oz. of white sugar,
the peel of half a lemon, I teaspoonful of salt,
4 pints of water ; mix all well, set on the fire,
boil for ten minutes : it is then ready. Milk is
preferable to water if at hand.
No. 18. Arrow-Root Water. — Put into a pan
3 oz. of arrow-root, 2 oz. of white sugar, the
peel of a lemon, I teaspoonful of salt, 4 pints of
water ; mix well, set on the fire, boil for ten
minutes : it is then ready to serve, either hot or
cold.
No. 19. Rice Water. — Put 7 pints of water
to boil ; add to it 2 oz. of rice well washed, 2
oz. of sugar, the peel of two-thirds of a lemon ;
boil gently for three-quarters of an hour ; it will
reduce to 5 pints : strain through a colander : it
is then ready.
No. 20. Barley Water. — Put into a saucepan
7 pints of water, 2 oz. of barley, which stir now
and then while boiling; add 2 oz. of white sugar,
and the rind of half a lemon thinly peeled ; let
it boil gently for about two hours, without
covering it : pass it through a sieve or colander :
248 THE HOSPITAL STEWARD'S MANUAL.
it is then ready. The barley and lemon may
be left in it.
No. 21. Soger's Plain Lemonade. — Thinly
peel the third part of a lemon, which put in a
bowl with 2 tablespoonfuls of sugar ; roll the
lemon in your hand upon the table to soften it,
cut it into two lengthwise, squeeze the juice over
the peel, &c, stir round for a minute with a
spoon to form a sort of syrup; pour over a
pint of water, mix well, and remove the pips :
it is then ready for use.
If a very large lemon, fresh and full of j uice,
you may make a pint and a half, to a quart, add-
ing sugar and peel in proportion to the increase
of water. The juice only of the lemon and sugar
will make lemonade, but will then be deprived
of the aroma which the rind contains.
No. 22. Semi-Citric Lemonade. — Receipt for
50 Pints. — Put 1 oz. of citric acid to dissolve
in a pint of water ; peel 20 lemons thinly, and
put the peel in a large vessel with 3 lbs. 2 oz.
of white sugar well broken ; roll each lemon on
the table to soften it, which will facilitate the
extraction of the juice; cut them into two, and
press out the juice into a colander or sieve
THE HOSPITAL STEWARD'S MANUAL. 249
over the peel and sugar; then pour half a pint
of water through the colander, so as to leave
no juice remaining; triturate the sugar, juice,
and peel together for a minute or two with a
spoon, so as to form a sort of syrup and ex-
tract the aroma from the peel; add the dis-
solved citric acid, mix all well together, pour
on 50 pints of cold water, stir all well together:
it is then ready A little ice in summer is a
great addition.
No. 23. Soyer's Cheap Crimean Lemonade. —
Put into a bowl 2 tablespoonfuls of sugar, £ table-
spoonful of lime-juice ; mix well for one minute ;
add 1 pint of water, and the beverage is ready.
A little rum is an agreeable addition.
No. 24. Tartaric Lemonade. — Dissolve 1 oz.
of crystallized tartaric acid in a pint of cold
water, which put in a large vessel: when dis-
solved, add 1 lb. 9 oz. of white or brown sugar
(the former is preferable); mix well to form a
thick syrup ; add to it 24 pints of cold water,
slowly mixing well : it is then ready.
A similar beverage may be made of citric
acid, using, however, only 20 pints of water to
each ounce.
250 THE HOSPITAL STEWAED'S MANUAL.
No. 25. Cheap Plain Rice Pudding with-
out eggs or milk. — Put on the fire, in a mode-
rate-sized saucepan, 12 pints of water: when
boiling, add to it 1 lb. of rice, 4 oz. of brown
sugar, 1 large teaspoonful of salt, and the rind
of a lemon thinly peeled ; boil gently for half
an hour, then strain all the water from the
rice; add to the rice 3 oz. of sugar, 4 table-
spoonfuls of flour, I teaspoonful of pounded
cinnamon ; stir it on the fire carefully for five
or ten minutes ; put it in a tin or a pie-dish,
and bake.
The rice water poured off, as above directed,
may be made into a beverage, the juice of a
lemon being introduced to give it flavor.
No. 26. Rich Rice Pudding. — Put \ lb. of
washed rice in a stew-pan, 3 pints of milk, 1
pint of water, 3 oz. of sugar, 1 lemon-peel, 1
oz. of fresh butter ; boil gently half an hour,
or until the rice is tender; add 4 eggs well
beaten, mix well, bake quickly for half an hour,
and serve.
No. 27. Boiled Rice Semi- Curried (suitable
for cases of commencing diarrhoea). — Put 1
quart of water in a pot or saucepan; when boil-
THE HOSPITAL STEWARD'S MANUAL. 251
ing, add £ lb. of well-washed rice; boil fast
for ten minutes; then drain the rice on a
colander, put it in a saucepan greased slightly
with butter, let it swell slowly near the fire, or
in a slow oven, till tender ; each grain will then
be light and well separated; add a quarter of a
teaspoonful of curry-powder, mix together
lightly with a fork, and serve.
No. 28. Batter Pudding. — Break 2 fresh eggs
in a basin, beat them well; add one tablespoon-
ful and a half of flour, which beat up with your
eggs with a fork until no lumps remain ; add
a gill of milk and a teaspoonful of salt ; butter
a bowl, pour in the mixture, put some water
in a stew-pan, enough to immerge half-way up
the cup or bowl : boil for twenty minutes, or
till the pudding is well set; pass a knife to
loosen it, turn out on a plate, pour pounded
sugar over it, with or without a little butter,
and serve.
No. 29. Bread-and-Butter Pudding . — Butter
a tart-dish well, and sprinkle some currants
all round it ; then lay in a few slices of bread-
and-butter; boil 1 pint of milk, pour it on 2
eggs well whipped, and then on the bread-and-
252 THE HOSPITAL STEWARD'S MANUAL.
butter: bake in a hot oven for half an hour.
The currants may be omitted when not con-
venient.
No. 30. Bread Pudding. — Boil 1 pint of
milk, with a piece of cinnamon and lemon-
peel; pour it on 2 oz. of bread-crumbs, then
add 2 eggs, J oz. of currants, and a little
sugar : steam it in a buttered mould, or pan,
for one hour.
No. 31. Custard Pudding. — Boil 1 pint of
milk with a small piece of lemon-peel and
half a bay-leaf for three minutes ; then pour
these on to 3 eggs ; mix it with 1 oz. of sugar
well together, and pour it into a buttered
mould or pan: set this in a stew-pan with
some water, steam it for twenty-five minutes,
turn it out on a plate, and serve.
No. 32. Stewed Macaroni. — Put in a stew-
pan 2 quarts of water, half a tablespoonful of
salt, 2 oz. of butter; set on the fire; when
boiling, add 1 lb. of macaroni, broken up rather
small; when boiled very soft, throw off the
water; mix well into the macaroni a table-
spoonful of flour, add enough milk to make it
THE HOSPITAL STEWARD'S MANUAL. 253
of the consistency of melted butter, boil gently
twenty minutes, add in a tablespoonful of
either brown or white sugar, or honey, and
serve.
A little cinnamon, nutmeg, lemon-peel, or
orange-flower water may be introduced to im-
part a flavor ; stir quick. A gill of milk or
cream may be thrown in three minutes before
serving. Nothing can be more light and nutri-
tious than macaroni done in this way.
No. 33. Macaroni Padding. — Put 2 pints ol
water to boil; add, when boiling, 2 oz. of maca-
roni, broken in small pieces ; boil till tender ;
draw off the water, and add half a tablespoonful
of flour, 2 oz. of white sugar, a quarter of a
pint of milk, and boil together for ten minutes ;
beat an egg up, add it to the other ingredients
with a nut of butter : mix well, and bake, or
steam. It can be served plain, and may be
flavored with either cinnamon, lemon, or some
essence.
No. 34. Sago Pudding. — Put in a pan 4 oz.
of sago, 2 oz. of sugar, half a lemon-peel, or a
little cinnamon, a small nut of fresh butter,
and half a pint of milk ; boil for a few minutes,
254 THE HOSPITAL STEWARD'S MANUAL.
or until rather thick, stirring all the while.
Beat up 2 eggs, and mix quickly with the
same: it is then ready for either baking or
steaming.
No. 35. Tapioca Pudding. — -Put in a pan 2
oz. of tapioca, li pint of milk, 1 oz. of white
or brown sugar, and a little salt ; set on the
fire; boil gently for fifteen minutes, or until
the tapioca is tender, stirring now and then to
prevent its sticking to the bottom, or burning;
then add 2 eggs well beaten : steam, or bake,
and serve. It will take about twenty minutes
steaming, or a quarter of an hour baking
slightly. Flavor with either lemon, cinna-
mon, or any other essence.
No. 36. Toast and Water. — Cut a piece of
crusty bread, about \ lb. in weight, place it
upon a toasting-fork, and hold it about six
inches from the fire ; turn it often, and keep
moving it gently until of a light yellow color;
then place it nearer the fire, and when of a
good brown chocolate color, put it in a jug
and pour over 3 pints of boiling water ; cover
the jug until cold, then strain it into a clean
vessel, and it is ready for use. Never leave the
THE HOSPITAL STEWARD'S MANUAL. 255
toast in it, for in summer it would cause fer-
mentation in a short time.
A piece of apple, slowly toasted till it gets
quite black, and added to the above, makes a
very nice and refreshing drink for invalids.
No. 37. — Figs and Apple Beverage. — Have
2 quarts of water boiling, into which throw 6
dry figs previously opened, and 2 apples, cut
into six or eight slices each ; let the whole boil
together twenty minutes, then pour them into
a basin to cool : pass through a sieve. The
figs, if drained, will be good to eat with a little
sugar, or jam.
No. 38. — Egg Soup. — Beat an egg perfectly
light, beating white and yolk at first sepa-
rately, and when light mixing them well
together ; add a teaspoonful of powdered sugar,
a little nutmeg, and while stirring briskly pour
in a whieglassful of boiling water, and then
add a wineglassful of sherry wine.
No. 39. Omelets with Fine Herbs. — Six
eggs will make a nice omelet for two persons.
Break them carefully into a bowl, as a tainted
egg will spoil all ;the rest; add three-quarters
256 THE HOSPITAL STEWARD'S MANUAL.
of a tablespoonful of salt, a quarter ditto of pep-
per, two of chopped parsley, and half a one of
fine-chopped onions. Beat them well. Put 2
oz. of butter in a clean frying-pan, place it on the
fire, and, when the butter is very hot, pour in
the eggs, which keep mixing quick with a
spoon until all is delicately set; then let it slip
to the edge of the pan en masse, laying hold
of the handle and raising it slantwise, which
will give an elongated form to the omelet;
turning the edges, let it set a minute : turn on
a dish, and serve.
No. 40. For Bacon or Ham Omelets. — Cut
2 oz. of ham or bacon, not too salt, in small
dice; fry two or three minutes in the butter
before putting in the eggs, and proceed as
above.
No. 41. Boiled Eggs. — The water should be
boiling before the eggs are introduced. Three
minutes is long enough for soft-boiled and five
for hard-boiled eggs.
No. 42. Fried Steaks. — Cut the steak in
pieces of 8 oz. each ; flatten them to the thick-
ness of three-quarters of an inch, taking care
THE HOSPITAL STEWARD'S MANUAL. 257
that each piece contains a little fat. Put a
clean frying-pan on the fire, with half an ounce
of butter, which when browned a little is
ready to receive the steak; keep it on a rather
quick fire, turning it several times, and, when
cooking, season each side with one-fourth of a
teaspoonful of salt and a pinch of pepper. Six
minutes will do the steak; and by pressing it
with a fork or the finger you can ascertain
if it is equally done through. When done,
suspend the steak over the pan, to allow the
melted fat, if any, which clings to the meat,
to fall back into the pan.
No. 43. Fried CJwps. — Have a fine chop
weighing 8 oz., and three-quarters of an inch in
thickness, without too much bone or fat. Cook
the same as the steak, turning two or three
times until well browned on either side. The
fire for both should be brisk, as the surface of
the meat becomes thereby carbonized and re-
tains the juice.
No. 44. Broiled Chops and Steaks. — To broil
either, place them on a gridiron over a sharp
fire, and turn two or three times while cook-
22*
258 THE HOSPITAL STEWARD'S MANUAL.
ing. Six minutes will do either. Season as
for fried steaks.
More is lost in weight by broiling than by
frying; but the flavor is better, and the meat is
more succulent.
No. 45. Roast and Grilled Fowls. — Fowls
should be roasted whole, and divided into diets
according to size.
They should also be grilled whole, being
divided up the back and trussed as usual for
grilling. Kub over a little butter, and grill on
a moderate fire, turning several times and keep-
ing a light yellow color. When partly done,
season with a small teaspoonful of salt and a
little pepper. When done, rub over a little
fresh butter : serve whole or in portions.
No. 46. Fried Fish. — Any kind of fish,
though fried in fat, when properly done, does
not retain the slightest particle of fat which
would be prejudicial to the patient. This is
avoided by having the fat at a proper degree
of heat, which can be ascertained when it
begins to smoke, and when all boiling has
ceased. If you then dip your finger in water
and let a drop fall into the fat, it will hiss
THE HOSPITAL STEWARD'S MANUAL. 259
loudly, if properly heated. Fat over-heated
is equally unfit for use, which fact can be
ascertained by the quantity of black smoke
emitted by the fat, and by its making a disa-
greeable smell.
You may always ascertain when fish is done,
as then the flesh separates from the bone
easily with the aid of a fork, if tried in the
thickest part. Take care that it does not
over-do, which takes all the nutriment from
the fish.
No. 47. Broiled Fish. — Trim as for frying,
and dip in flour; butter very lightly over; put
on a gridiron, previously well greased, to pre-
vent sticking, over a very slow fire; turn once.
Eight to ten minutes will do a fish of as many
ounces' weight.
Note. — This is the lightest and the most
difficult way in which fish can be dressed.
PART IV.
THE DISPENSARY.
261
CHAPTER. I.
General Arrangement and Management of the
Dispensary,
SECTION I. REQUISITIONS FOR MEDICAL SUPPLIES.
Requisitions for medical supplies are made
out in duplicate by the senior medical officer
of each hospital, post, or command. " If the
supplies are to be obtained from the principal
purveying depots, the requisitions will be made
upon the Surgeon-General, on the 31st day of
December annually; if from departments or
field-depots, they will be made upon the medi-
cal director, at such times and for such periods
as he may direct."*
Although these general rules are laid down,
however, it is to be understood that many cir-
cumstances may exhaust the supplies sooner
than was contemplated at the time of making
the requisition ; and, as no medical officer will
Revised Reg., Art. XLIV. \ 1231.
263
204 THE HOSPITAL STEWARD'S MANUAL.
be held blameless who permits his supplies to
become exhausted without providing for re-
plenishing them, it may become necessary at
any time to make a special requisition to sup-
ply deficiencies.
" In every case of special requisition, a dupli-
cate of the requisition shall at the same time
be transmitted to the Surgeon-General, for his
information, giving the name and station of
the officer upon whom it is made."*
The following is the form of a requisition
for medical supplies : —
* Revised Reg., Art. XLIV. g 1235.
THE HOSPITAL STEWAKD's MANUAL. 265
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&1.
2? a
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23
266 THE HOSPITAL STEWARD'S MANUAL.
On frontier and other posts remote from a
medical purveyor, it may occasionally become
necessary to purchase medical supplies. A
special requisition is then made by the surgeon
on a quartermaster, with the approval of the
commanding officer. The quartermaster makes
the purchase and furnishes the articles called
for. The forms for this purpose are but rarely
needed, and are not, therefore, reproduced in
this place, but may be found in the Revised
Regulations for the Army, Art. XLIY., Forms
2 and 3.
The special duty of the hospital steward in
connection with these requisitions is to keep
himself informed of the stock of medicines,
dressings, and hospital stores on hand, and to
notify the surgeon when the supply of any
article — and especially of any important article
— approaches exhaustion, in order that there
may be time to replenish the stock by requi-
sition before it is completely expended.
Besides this, it is frequently convenient for
the hospital steward to make out the requi-
sitions in accordance with the foregoing form,
and carry them to the surgeon for his approval
and signature.
THE HOSPITAL STEWARD'S MANUAL. 267
SECTION II. THE SUPPLY TABLE.
The medical supplies and their quantities
are laid down in the standard supply tables,
and not left to the discretion of individual
surgeons.
The supply table contained in the "Revised
Regulations for 1861," however, has been found
in practice to present so many deficiencies and
imperfections that it has been abandoned, and
a new and carefully-prepared supply table sub-
stituted by order of the Surgeon-General.
When surgeons desire in any case, or for any
special reasons, articles or quantities not laid
down in this supply table, their requisitions,
accompanied by the reasons therefor, must be
sent to the Surgeon-General for his approval.
The revised supply table of 1862 has just
been printed, and will be immediately dis-
tributed to medical officers.
SECTION III. SEMI-ANNUAL RETURNS.
Medical officers in charge of medical supplies
were directed, by Revised Regulations, to make
duplicate returns of them annually to the
Surgeon-General on the 31st of December.
By a circular from the Surgeon-General's office,
268 THE HOSPITAL STEWARD'S MANUAL.
dated May 5, 1862, this has been modified,
however, and the duplicate returns are to be
made semi-annually, on June 30 and December
31, to the medical director of the military dis-
trict in which they are serving, as well as to
the Surgeon-General. Similar returns are also
to be made by all medical officers when relieved
from the duty to which their returns relate.
The returns must set forth the quantity of
each article received, expended, and remaining
on hand. They are also, under the head of
Remarks, to show the condition of the stores,
and particularly of the instruments, bedding,
and furniture. The following is the form to
be employed :—
THE HOSPITAL STEWARDS MANUAL.
269
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O
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09
ft
0 CU
C". o
S". ts"
to e»
00 1
• P
o
a
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00
o
l-J
On hand at last return.
Received since last return.
Total.
Expended with the sick.
Issued.
Lost or destroyed by un-
avoidable accident.
Worn out, or unfit for use.
Total expended, &c.
On hand.
B
&
po
23*
270 THE HOSPITAL STEWARD'S MANUAL.
These returns are usually made out by the
hospital steward in charge of the dispensary,
and submitted to the surgeon for approval and
signature. In order to make out the return
correctly, the steward should keep in the dis-
pensary a memorandum-book in which, from
time to time, he should enter all articles lost
or destroyed by unavoidable accident, and
those worn out or unfit for service. The quan-
tities on hand are to be determined by taking
carefully an account of stock at the time of
making the return; and, if the dispensary has
been properly managed, the difference between
the total quantity of each article expended,
and the quantities returned as issued, lost, or
destroyed, and worn out or unfit for service,
will represent the quantity expended with the
sick.
SECTION IV. ARRANGEMENT OF THE DISPENSARY.
The various medicines, &c. kept in the dis-
pensary must be arranged in some convenient
order to facilitate dispensing. Every article
should have its place, and should be kept in it
except when actually in use.
The room selected for the dispensary should
be dry, well lighted, and conveniently situated
THE HOSPITAL STEWARD'S MANUAL. 271
in relation to the other parts of the house.
Where possible, water should be introduced
by pipes, with a small sink and waste-pipe for
the discharge of slops. Shelves should be put
up adapted to the various sizes of the bottles
and other original packages in which drugs are
received from the purveyor, with a convenient
number of drawers and closets.
A definite system should be kept in view in
the arrangement of the stores upon the shelves
and in the drawers and closets. Various plans
of classification have been proposed: perhaps
the most satisfactory is as follows : —
The several forms of preparations should be
put together, — tinctures in one place, fluid ex-
tracts in another, extracts in a third, volatile
oils in a fourth, and so on. The powerful
alkaloids, morphia, strychnia, veratria, &c,
should be kept carefully in a separate place,
which should be secured with a lock and key.
The liquors kept in the dispensary should
also be kept under lock and key.
The several articles of each class may be
arranged alphabetically, or in such other order
as is regarded as convenient. Where possible,
it is best, as a general rule, to put the whole stock
upon the shelves : by this plan only will it be
272 THE HOSPITAL STEWARD'S MANUAL.
possible to know readily what the stock on
hand is, and when the supply of any article
has been so nearly exhausted as to make it
proper to require for more. Room may be
made by putting the bottles several deep upon
the shelves, taking care to put in the back
rows bottles containing the same article only
as those in front of them. Thus, for example,
if there are a dozen bottles of tincture of opium,
they may be arranged in three rows of four
each, or, if the shelves are wide enough, in
four rows of three each. One bottle only
should be opened at a time, a second not being
uncorked until the first is exhausted, when
the empty bottle should be removed from the
shelves and transferred to a closet specially
assigned as a receptacle for empty bottles. To
insure this, only one bottle at a time should
have the original paper wrapper removed.
The same remarks apply to jars containing
cerates, extracts, and so on.
The bottles and jars should be put upon the
shelves, with the labels turned out, so that
they may be seen at a glance.
The stock of liquors should not be kept in
the dispensary, but in the room devoted to
hospital stores, — a small supply, enough at the
THE HOSPITAL STEWARDS MANUAL. 2/o
most for a few days only, being kept on hand
in the liquor-closet of the dispensary.
Sponge, adhesive plaster, bandages, lint,
muslin, and all similar articles, should be kept
in separate drawers, each labelled with its
contents.
The pestles and mortars, pill-tiles and pill-
machines, spatulas, &c, should be kept in a
closet or on shelves especially assigned to
them. They should never be put away foul,
but should invariably be cleansed thoroughly
after using.
The dispensary should be furnished with a
counter or table of convenient height, on which
the scales and weights should be placed, and
on which the various manipulations necessary
in putting up prescriptions are performed.
The scales should be kept scrupulously
clean and free from dust, as well as from
stains and rust: otherwise all accuracy in
weighing is impossible.
The water-faucet and the sink should be
behind the counter.
No one should be allowed behind the coun-
ter but the steward in charge of the dispen-
sary and his assistants.
All parts of the dispensary should be kept
274 THE HOSPITAL STEWARD'S MANUAL.
scrupulously clean. The bottles and jars on
the shelves should be dusted off with a feather
brush daily, and from time to time they should
be wiped with a damp cloth, as should also
the shelf on which they stand. In performing
this duty, the attendant executing it should
begin at the topmost row of shelves, and, re-
moving all the articles from one shelf at a
time, should first wipe off the shelf, and, sub-
sequently wiping off the bottles and jars, re-
place them each as it is cleansed in the same
order as before. The steward in charge of
the dispensary should have at least one assist-
ant, whose duty it shall be to clean the pestles
and mortars, pill-tiles, spatulas, &c. &c, keep
the shelves and room clean, and make himself
generally useful.
SECTION V. CARE OF SURGICAL INSTRUMENTS.
Surgical instruments may be kept by the
surgeon under his own personal care, but
frequently, also, their care is intrusted to the
steward in charge of the dispensary. The
following precautions may be hinted : —
Surgical instruments should be invariably
cleaned immediately after using. Tepid water
THE HOSPITAL STEWARD'S MANUAL. 275
answers very well for this purpose : hot water
is injurious to the handles ; with cold it is more
difficult to remove dried blood. A little castile
soap may be employed to get rid of the grease.
After washing, they should be wiped perfectly
dry, and, if stained, may be rubbed with a
chamois-skin on which is placed a little rouge
or tripoli. They should then be drawn a few
times over a razor-strop, wiped with a clean
chamois, and replaced in their cases.
Under no circumstances should more than a
few hours be allowed to elapse, after using in-
struments, before they are cleansed. The proper
time, however, when possible, is immediately
after the surgeon has done with them.
When the edges become dull, the instru-
ments may be honed in the following manner : —
A little oil being put upon the hone, the
knife is taken in the right hand, while the
hone is steadied with the left; the blade is laid
obliquely, and, being held steadily at an angle
of say thirty degrees, is drawn over the stone
edge foremost, from heel to point, with a steady
motion; the blade is then reversed, so as to
bring the other side to the stone, and drawn
back in the same manner, also, from heel to
point.
276 THE HOSPITAL STEWARD'S MANUAL.
This is repeated a number of times, until the
requisite edge is obtained, when it is finished
by drawing it a few times over a razor-strop.
The character of the edge is determined by the
angle at which the blade is held. If the angle
is great, a blunt edge, suitable for cutting dense
resisting structures, is obtained. If the angle
is small, a fine, delicate edge, suitable for dis-
sections of the soft parts, is given. The blade,
however, should not be laid flat upon the
stone, except in instruments where it has a
back thick enough to give the proper angle.
If, for example, a scalpel be sharpened by lay-
ing the blade flat upon the stone, the edge
becomes too thin, and is liable to be bent or
broken in use, constituting what is sometimes
described as a wire edge.
Instruments not in use should be kept in
their cases, the cases locked and covered by
the gutta-percha or leather pouch in which it
belongs. Once a month they should be ex-
amined, and any commencing rust be removed
by the use of a little rouge or tripoli, as above
directed. On the sea-coast, where the tendency
to rust is great, it is advisable to smear the
blades with a little mercurial ointment.
Instruments should be kept in a dry place,
THE HOSPITAL STEWARD'S MANUAL. 277
under lock and key, and not allowed to be
handled by any unauthorized person.
Care of the surgical instruments is especially
necessary, not only because without it they
soon become unfit for service, but also because
it is directed that "these instruments will be
accounted for to the Surgeon-General on the
31st day of December annually, in a special
return, in which the true condition of each
must be stated ; and, if any be lost or damaged,
a report of the facts and circumstances attend-
ing such loss or damage must be given."*
* Revised Reg., Art. XLIV. \ 1304.
24
278 THE HOSPITAL STEWARD'S MANUAL.
CHAPTER II.
Hints on Pharmacy for Hospital Stewards.
SECTION" I. — REMARKS ON PRESCRIPTIONS.
Upon the steward in charge of the drug-
store devolves the responsibility of compound-
ing the prescriptions of the medical officers.
The following brief remarks on this subject
may perhaps, therefore, be found useful.
The prescription is headed with the name
of the patient for whom it is intended. Then
follows the list of ingredients and quantities,
preceded by the character 1^, which is an ab-
breviation of the Latin word recipe, " take." The
officinal names of the several ingredients are
employed. The steward will, however, gene-
rally notice a difference between the termina-
tion of the officinal name and that of the name
employed in the prescription. This is owing
to the names being written in the Latin geni-
tive case, the verb recipe governing the genitive.
Thus, the surgeon writes, Jty Chloroformi 3j,
instead of "Chloroformum," which is the nomi-
THE HOSPITAL STEWARD'S MANUAL. 279
native, chloroformi being in the genitive case,
and meaning " of chloroform"
Thus, also, 1^ Zinci sulphatis grs. xx : Zinci
sulphas being the nominative.
A still greater difficulty in the way of the
steward occurs from the fact that surgeons
very frequently abbreviate the officinal names
for convenience, in writing their prescriptions,
writing, for example, Hyd. chl. mit. for Hy-
drargyri chloridum mite ; Potas. Iod., for Po-
tassee iodidum, &c. &c. As these abbreviations
are, unfortunately, not always made in the
same manner by different surgeons, a very long
list of abbreviations might here be given, with-
out exhausting the subject; and as it is directed
in army regulations that no person shall be
enlisted a hospital steward unless he is suffi-
ciently skilled in pharmacy for the proper per-
formance of his duties, it is presumed that
such a list would be unnecessary here. Most
of the abbreviations, moreover, at once explain
themselves to any one familiar with the offici-
nal names of the articles, as the steward should
certainly be with those on the army supply
table. The general rule may, however, be laid
down, that the steward should under no cir-
cumstances allow himself to put up a prescrip-
280 THE HOSPITAL STEWARD'S MANUAL.
tion containing any abbreviation of the mean-
ing of which he entertains the slightest doubt.
In all such cases he should go at once to the
surgeon for an explanation. By so doing, he not
only avoids, at the time, mistakes which might
be fatal, but gradually becomes thoroughly ac-
quainted with all the abbreviations employed
by the surgeon under whom he serves.
The quantities of the several ingredients
employed are indicated by the usual symbols
with Roman numerals affixed. Thus: —
Weights. Measures.
gr. a grain; gtt. a drop;
9, a scruple; "fl|, a minim;
3, a drachm; fg, a fluidrachm;
%, an ounce; fg, a fluidounce;
ft), a pound. 0; a pint ;
Cong, a gallon.
The Roman numerals follow these signs,
thus: — gyj, i.e. six drachms ; fgxj, i.e. eleven
fluidounces.
The following tables may be given for refer-
ence : —
Apotliecariei Weight.
Pounds. Ounces. Drachms. Scruples. Grains.
ft, 1 = 12 = 96 = 288 = 5760
§ 1 • = 8 ■ = 24 = 480
31 = 3 = 60
9 1 = gr 20
THE HOSPITAL STEWARD'S MANUAL. 281
Avoirdupois Weight.
Pound. Ounces. Drachms. Grains (Apothecaries').
lb 1 = 16 = 256 = 7000
oz. 1 = 16 = 437.5
dr. 1 = 27.34375
Weighing for prescriptions is always done in
accordance with apothecaries' weight. Avoir-
dupois-weight is used for most other purposes,
as in weighing groceries or commissary stores.
It is, moreover, very frequently employed in
the case of drugs also, when they are sold or
issued in bulk, — a circumstance of some im-
portance to bear in mind, as the actual value
of the pounds, ounces, and drachms of the two
kinds of weight is so unlike.
Apothecaries' Measure.
Gallon. Pints. Fluidounces. Fluidrachms. Minims.
Cong. 1 = 8 = 128 = 1024 = 61440
O. 1 = 16 = 128 == 7680
fg 1 = 8 = 480
%1 = 1U60
The following remarks may be added with
regard to certain domestic measures frequently
alluded to in the administration of remedies.
A teacup is estimated to contain about four
fluidounces or one gill. A wineglass, two fluid-
24*
282 THE HOSPITAL STEWARD'S MANUAL.
ounces. A tablespoon, half a fluidounce. A
teaspoon, a fluiclrachm.
The steward may here be cautioned against
the frequent mistake of identifying the drop
with the minim. The minim is a fixed and
unchangeable measure, which varies neither
with the nature of the liquid nor the manner
in which it is poured out. The drop, on the
other hand, is exceedingly variable, differing in
size considerably for different liquids, and even
for the same liquid, in accordance with the
shape of the bottle from which it is poured, and
many other circumstances.
As an illustration of the variation caused by
the nature of the liquid, it may be stated that
in the experiments of Mr. E. Durand, of Phila-
delphia, on this subject, it was found that while
150 drops of sulphuric ether were necessary to
make a fluidrachm, it required 132 of the tinc-
ture of the chloride of iron, 120 of aromatic
sulphuric acid, 120 of laudanum, 78 of black
drop, 57 of Fowler's solution, and but 45 of
distilled water, for the same purpose.
The list of the articles and their quantities
is followed in the prescription by short di-
rections as to compounding it. These are
generally written in Latin, and are frequently
THE HOSPITAL STEWARD'S MANUAL. 283
abbreviated. The following are the abbrevia-
tions most commonly employed : —
M. — Misce. — Mix.
Ft. pulv. — Fiat pulvis. — Make a powder.
Ft. pulv. xij. — Fiant pulveres xij . — Make twelve
powders.
Ft. imlv. et div id. in chart, xij. — Fiat^
pulvis et divide in chartulas xij. Make
Ft. pulv. in ch. xij. cliv. — Fiat pulvis )■ twelve
in chartulas xij. dividenda. powders.
Ft. ch. xij. — Fiant chartulse xij.
Ft. solid. — Fiat solutio. — Make a solution.
Ft. inject. — Fiat injectio. — Make an injection
(for urethra).
Ft. collyr. — Fiat collyrium. — Make an eye-
wash.
Ft. enema. — Fiat enema. — Make an injection
(for rectum) .
Ft. mas. — Fiat massa. — Make a mass.
Ft. pil. xij. — Fiant pilulse xij.
Ft. mas. in pil. xij. div. — Fiat massa Make
in pilulas xij. dividenda. V twelve
Ft. mas. et div. in pil. xij. — Fiat massa pills.
et divide in pilulas xij.
Ft. in/us. — Fiat infusum. — Make an infusion.
Ft. haust. — Fiat haustus. — Make a draught.
284 THE HOSPITAL STEWARD'S MANUAL.
Ft. garg. — Fiat gargarisma. — Make a gargle.
Ft. mist. — Fiat mistura. — Make a mixture.
Ft. emuls. — Fiat emulsio. — Make an emulsion.
Ft. ung. — Fiat unguentum. — Make an oint-
ment.
Ft. linim. — Fiat linimentum. — Make a lini-
ment.
Ft. troch. xxiv. — Fiant trochisci xxiv. — Make
twenty-four lozenges.
After the directions as to compounding,
follow those as to administration. These are
always written in English, the direction being
prefixed by the abbreviation S. — Signatura.
The directions are followed by the date and
the signature of the medical officer.
The prescription, therefore, consists properly
of three parts : —
1. The list of ingredients and quantities pre-
fixed by the sign ty.
2. The directions as to compounding, — gene-
rally a Latin abbreviation.
3. The directions for administration. These
are preceded by the name of the patient, and
followed by the date and the signature of the
medical officer.
THE HOSPITAL STEWARD'S MANUAL. 285
SECTION II. — COMPOUNDING AND DISTRIBUTION OF
PRESCRIPTIONS.
Having read the prescription, the steward
proceeds to compound it, varying his process
according as it is a solution, a mixture, pow-
ders, or pills, &c, that he is to prepare.
Where the prescription consists of liquids
only, they are measured seriatim in the gradu-
ated measure and poured into the phial which
is to receive them, when the process is com-
pleted by corking and gently agitating the
mixture.
In performing this duty, but one bottle
should be taken down from the shelves at a
time. The measure should be held by the
thumb and finger of the left hand, and the
stopper should be seized by the little finger of
the same hand. The bottle is held in pouring
with the right hand. The measure is held
well up before the eye, so as to observe the
quantity with accuracy; and, when it is ob-
tained, the stopper is replaced, and the bottle
put back in its place upon the shelf before pro-
ceeding to the next ingredient.
Where the ingredients of the prescription
are partly solids and partly liquids, the quan-
286 THE HOSPITAL STEWARD'S MANUAL.
tities of the solids are to be determined by
weight.
If the solids are saline or other soluble sub-
stances, and a solution is to be made, it is
generally best to bruise them in a mortar
with the liquids until their solution is effected,
after which the product is transferred to a phial.
Where insoluble solid matters are to be sus-
pended in the form of a mixture or emulsion,
the mortar becomes still more important. The
ingredients are to be rubbed steadily together
until a smooth and uniform liquid is obtained,
and the label of the phial into which the mix-
ture is introduced should contain directions to
shake well before administration.
When the prescription directs the prepara-
tion of any given number of powders, the
ingredients in powder are carefully weighed
out and thoroughly mixed together on a pill-
tile with a spatula, or, preferably, in a mortar.
The mixture having been completed, the pro-
duct is to be divided into the number of equal
parts called for by the prescription, the division
being effected by the scales or the eye, accord-
ing to the nature of the ingredients and the
importance of accuracy. Each portion is then
transferred to the paper in which it \s to be
THE HOSPITAL STEWARD'S MANUAL. 287
folded. The papers for each set of powders
should be neatly cut and of equal size. The
folding is effected in the following manner. A
crease is made by folding over the edge along
the long side of the paper, at about one-third
of an inch from the margin. The opposite edge
is then laid in this crease, and the paper folded
over longitudinally, so as to give the proper
width. The ends are then folded over a
spatula, to make the flaps of a proper width.
Uniformity in the size of the powders is
exceedingly desirable. It may readily be
attained by cutting out a small wooden gauge
of the desired size, by which both the length
and width of the powder may accurately be
determined.
In the preparation of Pills, the materials for
the whole number of pills, as directed by the
prescription, are first to be weighed separately,
then worked into a mass of the proper con
sistence, and afterwards divided into the num-
ber of pills called for.
To make a pill-mass where the ingredients
are all dry powders, without increasing un
necessarily the size of the pills, requires often
considerable ingenuity.
In the case of certain vegetable powders.
288 THE HOSPITAL STEWARD'S MANUAL.
such as aloes, rhubarb, and opium, a mass suit-
able for rolling into pills may readily be formed
by the aid merely of a small quantity of water,
the powder being beat into a mass in a mortar
during the gradual addition of the fluid.
Where, however, the powder is of an unad-
hesive character, as is the case, for example,
with many vegetable powders and metallic salts,
some adhesive ingredient must be added to
them to enable a mass of pillular consistence
to be formed.
Molasses answers an excellent purpose in
very many cases. It must be added carefully,
as an excess will make the pill-mass too fluid
for manipulation. Gum arabic in small quan-
tities may be added where the molasses does
not give the mass sufficient cohesion. It is
frequently used alone for this purpose, either
in the form of powder or of thick mucilage, but
is objectionable, as the pills produced by its use
are apt to become excessively hard on drying.
For many vegetable powders castile soap
answers very well, a small quantity readily
imparting the necessary consistence. Resinous
powders are particularly adapted to its use.
Where the prescription presents among its
constituents one or more semi-solid extracts, it
THE HOSPITAL STEWARD'S MANUAL. 289
will frequently be found that these impart suffi-
cient tenacity, and that by simply beating the
ingredients together a suitable mass is ob-
tained. But it sometimes happens, on the one
hand, that the quantity of the soft extract is too
small for the purpose, and then the addition of
some such articles as those above enumerated
becomes necessary ; and, on the other hand, the
extract may be of such quality and consistence
as to make the mass entirely too soft to be rolled
into pills. In the latter case the addition of
some dry powder, which shall not interfere with
the medicinal value of the prescription, becomes
necessary. Powdered liquorice-root or wheat
flour are well adapted for this purpose.
Where the materials to be made into pills
are wholly semi-solid or liquid, the addition of
some dry powder becomes yet more necessary.
Wheat flour is very generally available, and is
on the whole preferable to the crumb of bread,
which is recommended by many pharmaceutists.
Powdered liquorice-root, arrow-root, starch, and
gum arabic are also used for the same purpose.
Other articles may be necessary in special
cases, as, for example, magnesia in making
pills out of balsam of copaiva.
Many other articles are used by pharmaceu-
25
290 THE HOSPITAL STEWARD'S MANUAL.
tists in giving elegance and consistence to pills.
It is not, however, considered desirable to enu-
merate them in this place, because in most
general hospitals treatises on pharmacy are
accessible, and because those above mentioned
comprise the chief that will be found accessible
to the hospital steward in the field and at
remote posts.
The pill-mass, having been properly formed,
is next to be divided into the number of pills
directed. This may be done either by a spatula
upon a pill-tile, or with a pill-machine.
In the first case the pill-mass is rolled out
upon the tile into a cylinder corresponding in
length to the number of pills to be made, which
is ascertained by measuring it upon a scale
which is marked upon the surface of the tile.
The rolling may be commenced with the hand
and finished with the spatula. The cylinder
is then cut by the spatula into equal pieces,
one for each pill, in accordance with the same
scale, which is generally ruled up to 18 or 24
pills. The pills are then finished by rolling
them separately between the fingers or on the
palm of the hand.
In general hospitals the steward is furnished
with a pill-machine, by which pills may be
THE HOSPITAL STEWARD'S MANUAL. 291
made neatly with considerable rapidity. It
consists of a smooth base-piece, in one part of
which a number of parallel grooves (18 to 24)
are made, and of a roller with a handle on each
end, the back of which is smooth and the
under surface grooved to correspond with the
grooves in the base-piece. The pill-mass hav-
ing been rolled on the smooth surface of the
base-piece with the back of the roller until it
is- long enough to cover as many grooves as it
is to make pills, the cutting surface of the
grooves is adjusted, and by the motion of the
roller the cylinder is at once divided into the
requisite number of pills, which, if the opera-
tion has been properly conducted, will be so
round as to require no further rolling.
The pills, having been completed either by
hand or the machine, are, if very moist, to be
spread out upon a sheet of paper with the edges
turned up, or upon the bottom of a shallow box,
to dry somewhat: they are finally introduced
into a pill-box, if for dispensing, or into a
bottle if made to keep on hand. In either
case, some dry powder, such as starch, liquorice-
root, or pulverized sugar, should be introduced
to keep them from sticking together.
Where ointments and cerates are prescribed
292 THE HOSPITAL STEWARD'S MANUAL.
containing several ingredients, they may very
often be compounded upon the pill-tile by means
of the spatula. Occasionally, however, the
employment of heat is necessary to make the
ingredients combine.
Cerate of Spanish flies may be spread for
blisters by means of a spatula slightly warmed.
Perhaps the best substance to spread it upon
is ordinary adhesive plaster, spreading the
cerate so that a margin of half an inch is left
uncovered. This will serve to keep the blister
in its place.
Plasters proper, usually require heat to spread
them upon the prepared sheep-skin which is
furnished for that purpose. The heat is best
obtained by means of a hot iron of the proper
shape (plaster-iron). Care must be taken not
to heat the iron too hot, or the sheep-skin is
shrivelled and the adhesiveness of the plaster
diminished.
The prescription, having been put up, must
not, whatever its nature, be allowed to leave
the dispensary without a label. The labels
usually employed in civil practice are not
adapted to military hospitals, where the label
should at once indicate whom the prescription
is for, and give information to the nurse as to
THE HOSPITAL STEWARD'S MANUAL. 293
its administration, and to the surgeon as to its
composition. The label must therefore be, in
fact, a copy of the prescription, and should be
made out in the following form : —
FOR PRIVATE JAMES SIMPSON,
WARD 2, BED 14.
R — Pulveris opii, grs. vj.
Cupri sulphatis, grs. iv.
Ft. mas. in pil. xxiv div.
S. One pill to be taken every three hours.
2, 16, 1862.
Surgeon, U.S.A.
This label should be written upon a neat
slip of wrhite paper, about two inches wide by
five or six long. It may be pasted upon bot-
tles if considered desirable ; but, as the same
bottles in a military hospital are to be used
again and again, it will save labor in clean-
ing the bottles to tie the labels upon them.
The corners of the label may be folded ob-
liquely at one end, so as to form a point, and
this may be tied to the neck of the phial by a
thread. The label for pill-boxes may be se-
cured in the same way to the bottom part of
the box, leaving the lid free. For packages
.294 THE HOSPITAL STEWARD'S MANUAL.
of powders or other packages, the label should
be pasted upon the paper wrapper.
In putting up prescriptions, those for each
ward should be put up together, attending
to the wards seriatim in the order in which
their prescription-books come to the dispen-
sary in the morning. So soon as the pre-
scriptions for any ward are complete, the
chief nurse of the ward is to be notified, and
will send an attendant to bring the medicines
to the ward, where they will be distributed to
the beds to which they belong, and admi-
nistered strictly in accordance with directions.
PART V.
HINTS ON MINOR SURGERY AND DRESSINGS
FOR HOSPITAL STEWARDS.
295
CHAPTER I.
On Dressings,
SECTION I. GENERAL PREPARATIONS FOR
DRESSINGS.
To facilitate the dressing of wounds, it will
generally be found convenient in hospitals to
keep on hand one or more trays for dressings,
which may be prepared in the following man-
ner:—
A shallow box should be made, two feet long
by eighteen inches wide and four inches deep,
divided into equal halves by a partition which
rises in the centre to the height of eight inches,
and has an opening cut in it in such a manner
as to serve for a handle.
In this box should be placed and kept con-
stantly on hand the following articles, in
quantities which will vary with the number
of dressings to be performed daily in any par-
ticular hospital: —
Patent lint, neatly rolled ; some charpie, or
packed lint; an assortment of roller-bandages
297
298 THE HOSPITAL STEWARD^ MANUAL.
of various widths; adhesive plaster cut into
strips three-fourths of an inch wide, also a roll
uncut; isinglass plaster; two bundles of liga-
tures ten inches long, composed each of a
single thickness of saddler's silk well waxed,
and one of ligatures of two thicknesses twisted
together, each bundle consisting of at least
a dozen ligatures laid side by side, and sur-
rounded for about half their length by a roll
of paper fastened by a pin, so that the ligatures
may be drawn out one at a time as wanted; a
large pair of scissors ; a sheet of patent lint
eighteen inches square, neatly spread on one
side with simple cerate; a pincushion amply
provided with pins at one end, with from
three to a dozen surgical needles ready-threaded
at the other; a pocket-set of instruments; three
to a dozen towels; and some sponges.
Besides this tray of dressings, basins with
warm water, a bucket to receive soiled dress-
ings, and a tin can filled with boiling water to
heat the adhesive plaster, will be needed.
The surgeon who makes the dressings will
generally need one attendant to carry the tray,
and one for the basins and sponges, the bucket
for soiled dressings, &c.
The attendant who carries the tray should
THE HOSPITAL STEWARD'S MANUAL. 299
make himself thoroughly familiar with its con-
tents and their respective j>laces, and should
be able at once to hand to the surgeon any
article in it he may ask for, and to return it
to its place when he has done with it.
The attendant who manages the sponges
should keep constantly ready for the surgeon
a clean basin of tepid water, with two or more
well-soaked sponges, and as fast as one is soiled
replace it with another, empty out the soiled
water, and wash the soiled sponges, so as to
be ready for the next patient, at the same
time keeping an eye to the surgeon so as to
hand him the can to heat adhesive plaster
whenever he needs it.
SECTION H. ON THE DRESSING OF WOUNDS.
In the army hospitals of the United States as
at present organized, the dressings are usually
made by the surgeons, assistant surgeons, and
medical cadets, and comparatively seldom by
the hospital stewards: no elaborate treatise on
dressings is, therefore, required in this place.
Bat as occasionally, and especially in the field
and at remote posts, a certain portion of the
dressings are necessarily made by the hospital
300 THE HOSPITAL STEWARD'S MANUAL.
steward, a few practical hints on the subject
may be appropriate in this work.
The arrest of hemorrhage and the treatment
of fractures, the introduction of sutures, and
other steps requiring surgical skill and judg-
ment, must, of course, receive the personal
attention of a medical officer. The remarks
here to be made are, therefore, limited to the
dressings proper.
The dressing most generally found available
for all wounds, whether incised, lacerated,
gun-shot, or caused by surgical operations, is
the water-dressing, either cold or warm, accord-
ing to circumstances.
As a general rule, it may be said that cold-
water dressings should be employed whenever
the design of the application is to limit the
degree of inflammation ; warm-water dressings,
where the design is to favor suppuration : at
the same time, it should be understood that
whenever the cold-water dressing is decidedly
disagreeable to the patient, and especially
when it causes shiverings or rigors, it should
be at once discontinued and the warm-water
dressing substituted.
The experience of our army surgeons is also
in favor of dressings of the simplest kind, and
THE HOSPITAL STEWARD'S MANUAL. 301
opposed to all complicated systems of band-
aging. The roller-bandage especially is liable
to abuses, and should never be employed
except in cases of fracture and where it is
desirable to produce a certain degree of press-
ure.
The various complicated and beautiful band-
ages described and figured in the treatises on
minor surgery will be found in practice, if
applied to the treatment of wounds, to be not
only troublesome and tedious, but in their
results unclean, uncomfortable, and positively
injurious.
The cold-water dressing as applied to a gun-
shot wound should consist simply of a small
piece of lint folded double, saturated with
cold water, and retained over the orifice of
the wound by a couple of strips of isinglass
or adhesive plaster. In incised or other
wounds in which adhesive strips are necessary
to retain the lips of the wound in apposition,
the water-dressing may be applied above the
strips and retained in the same manner.
Usually no bandages of any kind are necessary.
Where a greater degree of cold is necessary,
and especially where much inflammatory action
is developed in the limb around the wound,
26
302 THE HOSPITAL STEWARD'S MANUAL.
irrigation should be resorted to. This is best
effected by covering the parts to be irrigated
with a double thickness of wet lint; cold
water — ice-water, if desirable — is to be placed
in a basin on a small table near the bedside ;
one or more strands of cotton lamp-wick are
to be arranged with one end in the basin and
the other laid upon the wet lint, or a strip or
two of linen bandage may be used if lamp-
wick cannot be obtained. By capillary action,
a constant supply of cold water is taken up
from the basin and deposited on the lint cover-
ing the limb. The limb should be placed on
a piece of oiled silk or gutta-percha cloth so
arranged that all the superfluous water may
be drained into a bucket placed at the bedside.
This simple mode of irrigation is quite as
good for most cases as any of the complex
forms of apparatus designed for this purpose.
Where a greater degree of cold is necessary,
a bladder may be filled with pounded ice and
laid upon the parts. This, however, should
never be done except by the express directions
of the surgeon ; and the greatest watchfulness
and care should be employed to avoid freezing
the surface.
The lint employed in these watei dressings
THE HOSPITAL STEWARD'S MANUAL. 303
6hould be changed at least once daily, or oftener
in cases of profuse or offensive discharges.
Where the warm-water dressing is employed,
it may be applied in the same manner as dress-
ings of cold water; but it will here be found
that it is convenient to cover the wet lint with
a piece of oiled silk or gutta-percha cloth before
applying the adhesive strips : by so doing, the
warmth is much longer retained. Four or five
thicknesses of lint saturated with warm water
and thus covered will be found to retain
warmth and moisture as long and efficiently
as any poultice. Poultices are, moreover, un-
cleanly, disagreeable, and are very generally
discarded by army surgeons in the treatment
of wounds.
In healing wounds, when granulation is
fairly under way and the suppuration is
no longer profuse, lint spread with simple
cerate, retained in place by adhesive strips,
forms a simple and appropriate dressing. It is
also a dressing frequently resorted to imme-
diately after amputation and other operations,
before suppuration has set in.
304 THE HOSPITAL STEWARD'S MANUAL.
SECTION III. — OF THE ROLLER-BANDAGE AND ITS
APPLICATIONS.
Although, as above remarked, the roller is
to be avoided as much as possible in the treat-
ment of ordinary wounds, yet it is very gene-
rally needed in dressing fractures, and may be
required in many cases, as of chronic ulcers, &c,
where a certain degree of pressure is desirable.
A few remarks are, therefore, made on the roller
and its application.
The roller-bandage is composed of a strip
of muslin, usually one to four inches in
width and three to seven yards in length.
This is formed into a uniform and compact roll
by beginning at one end and rolling it towards
the other. Assorted roller-bandages of various
widths and lengths, ready rolled, are furnished
with the medical supplies of the army. Of late
a very elegant article, rolled with the greatest
precision by a steam apparatus, has been
supplied.
Rollers may, however, be readily made, if
not on hand, by tearing muslin into strips of
the proper width and rolling them according
to the following directions, which are also ap-
THE HOSPITAL STEWARD'S MANUAL. 305
plicable in re-rolling bandages which have been
used and washed.
To form a roller with the hands, begin at
one end and fold the extremity upon itself seve-
ral times, until a small cylinder of some solidity
is obtained; then the ends of this cylinder are
held and it is revolved between the thumb and
forefinger of one hand, while the strip is
passed smoothly between the thumb and fore-
finger of the other hand, in such a manner as
to give a little tension. A good and uniform
bandage can thus be made.
But in a large hospital, where many band-
ages are used, and where most of them are
306 THE HOSPITAL STEWAKD's MANUAL.
washed and re-rolled after using, the labor of
making rollers in this manner would be far too
great. A simple machine may in this case be
constructed for the purpose by any carpenter,
which will much facilitate the process. An
axis of iron or strong wood (oak or hickory) is
made eight or ten inches long, and about a
quarter of an inch in diameter at its thickest
end, with a slight taper towards the other
extremity. At the thickest extremity is a
handle to serve as a crank. This is to
be passed through holes in two uprights,
six or eight inches apart, set up in a
square piece of board in such a manner that it
THE HOSPITAL STEWARD'S MANUAL. ^307
can be readily made to revolve by the handle.
One or more cross-pieces of wood or wire are
so placed that the strip is smoothed by pass-
ing between them before it reaches the axis on
which it is rolled. The figure explains itself.
With such a machine a single attendant can
roll a large number of bandages in a compara-
tively short time.
In applying the roller, the free extremity is
laid with its external side next to the surface of
the limb, where it is held by the fingers of the
left hand until it is fixed by the subsequent
turns, the bandage being gradually unrolled
as it is applied by the right hand. When the
dressing is completed, the extremity of the
bandage is secured by a pin.
The roller receives various names, according
to the mode of its application.
The circular bandage is formed by passing
the roller circularly around the part so that
each turn covers in nearly or completely that
preceding it. This is also spoken of as " a few
circular turns of the roller."
When the roller ascends the limb obliquely,
each turn partly overlapping that which pre-
cedes, it is spoken of as the spiral bandage, or
'•spiral turns of the roller."
308 THE HOSPITAL STEWARD'S MANUAL.
The most usual application, however, when
a limb is to be covered in, is the reversed band-
age, or "reversed turns of the roller." This
is made as follows. The initial extremity of
the bandage having been fixed by a few cir-
cular turns, the reverses are made as follows : —
the upper edge of the bandage being fixed
with two fingers of the left hand, the right,
THE HOSPITAL STEWARD'S MANUAL. 309
which has been holding the roller in the
supine position, is to be pronated, and the
bandage carried gently around the limb in this
position until it reaches the corresponding
point in the next turn, where the process is to
be repeated; and so on up the limb. The
figures will explain this process.
Two of the most frequently-employed and
important applications of the reversed band-
age are the spiral of the upper and the spiral
of the lower extremities.
The spiral of the upper extremity requires a
roller two and a half inches wide and seven
or eight yards long.
It is applied as follows. Make a few cir-
cular turns around the wrist, beginning on the
radial and passing towards the ulnar side;
then carry the roller over the palm and back
of the hand to reach the ends of the fingers,
and ascend by simple spiral turns as far as the
thumb. The ball of the thumb and wrist are
then to be covered in by figure-of-8 turns, the
forearm ascended by spiral reversed turns to
the elbow, which is also to be covered in by
figure-of-8 turns, and the arm ascended in
the same manner as the forearm to the shoul-
310 THE HOSPITAL STEWARD'S MANUAL.
THE nosriTAL steward's manual. 311
der, where the free end of the bandage may be
secured by a pin. (See the figure).
The spiral of the loiver extremity requires a
bandage of the same dimensions, or perhaps
half an inch wider, as that of the upper
extremity.
Make a few circular turns around the ankle,
beginning at the outer and passing towards the
inner side ; then, on reaching the internal mal-
leolus, wind around it and over the tendo
achillis, just above the heel, over the space
between the external malleolus and the heel,
and cross the sole of the foot to the great toe.
Ascend by spiral turns from thence to the
instep, from which wind around the inner side
between the inner malleolus and the point of
the heel, over the tendo achillis, to the outer
side of the ankle above the malleolus, thence
over the instep and point of the heel back to
the instep, and make a figure-of-8 turn around
the ankle, the instep, and the sole, after which
ascend the leg by spiral reversed turns to the
knee. (See figure).
If the knee and thigh are to be covered, take
another roller, and, beginning below the knee,
cover it in with figure-of-8 turns, and ascend
the leg by spiral reversed turns to the groin.
312 THE HOSPITAL STEWARD'S MANUAL.
Besides the roller-bandage, pieces of muslin
of various sizes and shapes may be employed
as bandages. The most generally available
form is a square of muslin folded into a tri-
angle or like a cravat. For detailed accounts
of the application of these or other bandages,
the hospital steward may consult "Sargent's
Minor Surgery," which is now furnished with
medical supplies to the army hospitals.
THE HOSPITAL STEWARD'S MANUAL. 313
CHAPTER II.
Operations in Minor Surgery performed by the
Hospital Steward.
SECTION I. CUPPING.
By the term "cupping" is understood the
application to the surface of the body, at con-
venient points, of one or more small cup-shaped
vessels of glass or thin metal, from the cavi-
ties of which the air has been exhausted.
Two methods are employed, — "dry cupping,"
or the application of "dry cups," and "wet
cupping," or the application of "wet cups,"
called also sometimes "cut cups."
Dry cupping is effected by simply applying
to the surface to be cupped the number of
cups ordered, in such a manner as to produce
a partial vacuum in the cavity of each, into
which the integuments are forced by the at-
mospheric pressure without.
The manner in which this vacuum is pro-
duced will depend entirely upon the character
27
314 THE HOSPITAL STEWARD'S MANUAL.
of the cupping-apparatus furnished. Thus, it
may be produced by a small air-pump made to
fit upon the summit of each cup, in which is a
small orifice furnished with a valve opening
outward. Or it may be produced by a very
ingenious apparatus recently brought into use,
in which each cup has attached to its bottom
a globe of India-rubber. This is simply com-
pressed with the hand when the cup is applied,
and then, the pressure of the hand being re-
moved, the expansion of the globe by its elas-
ticity to its natural form produces the neces-
sary rarefaction of the included air.
The hospital steward, however, seldom has
these more elegant methods of cupping at
his command, the cupping-apparatus usually
furnished to him, both in hospital and in the
field, consisting simply of from six to a dozen
plain cupping glasses or tins, and a scarificator.
The vacuum is created in these ordinary cup-
ping glasses or tins by means of the heat
generated by the combustion of alcohol. The
inner surface of the cup may be moistened
with alcohol, which is ignited, and, while still
burning, applied to the skin; or a pellet of
cotton or strip of paper, moistened with alcohol
and ignited, may be dropped into the cup,
THE HOSPITAL STEWARD'S MANUAL. 315
which is to be applied while still burning. In
either case, the flame is extinguished as soon
as the cup is placed upon the skin, by the
rapid abstraction of the oxygen of the con-
tained air : so that there is no danger of burn-
ing the skin.
The object of "dry cups" is merely to pro-
duce congestion of the surface, with a certain
degree of ecchymosis, that is, discoloration from
blood effused in the integuments in conse-
quence of the rupture of minute vessels during
the process. Glass cups will, therefore, be
found more useful when they can be obtained,
because with them the degree of turgescence
can readily be observed during the process.
Wet cupping requires, besides the conges-
tion thus produced, that the congested surface
should be incised in a number of places with a
scarificator, and a certain flow of blood pro-
voked from these incisions by a reapplication
of the cups. In applying wet, or cut cups,
therefore, the number prescribed are first to be
applied in the same manner as in dry cupping,
and then, after they have produced a certain
amount of congestion, — say after five or ten
minutes' application, — they are to be removed
316 THE HOSPITAL STEWAKD'S MANUAL.
one at a time, the scarificator used, and the
cups reapplied.
The scarificator is an instrument by means
of which twelve to sixteen slight incisions can
be made simultaneously, by as many little
lancet-blades, over a surface about the size of
the cup. It is furnished with a screw, by means
of which the distance to which the lancet-blades
protrude, and the consequent depth of the in-
cisions, are regulated.
It is used by placing it upon the surface to
be scarified, after having first set the blades
back by pressing upon a lever made for that
purpose, and then, touching the spring, all the
incisions are instantly and neatly made.
The cup, having now been reapplied, is to be
kept on until about an ounce of blood has
flowed into it. And here again glass cups
present advantages over those of metal, since
with them the quantity of blood can readily
be discerned, and the cup removed as soon as
enough is taken.
Cut cups are, therefore, a method of local
blood-letting.
The operation being completed and the cups
all removed, the surface is to be cleansed from
blood, and a piece of dry muslin, or, if there is
THE HOSPITAL STEWARD'S MANUAL. ol7
much smarting, a cloth spread with simple
cerate, applied.
When cupping is to be performed on the
chest of thin persons, or upon the abdomen in
cases of enteritis or peritonitis, it will be found
that the previous application of a warm foment-
ation, or of a poultice, to the parts, will greatly
diminish their sensibility and the pain of the
operation.
SECTION" II. LEECHING.
Two kinds of leeches are employed in this
country, — European and American. Neither
of them are placed upon the supply table of the
army. In certain situations, however, they
are readily collected, and American leeches can
be purchased in most localities at a moderate
expense from the hospital fund.
In the application of leeches, the surface to
which they are to be applied must first be pre-
pared by washing it carefully with warm water.
If the part is hairy, it should be shaved. To
make the leeches take hold more readily, the
parts on which it is designed for them to fasten
may be moistened with sugar and water, or,
still better, with blood drawn from the tip of
27*
318 THE HOSPITAL STEWARD'S MANUAL.
the finger. The leeches are to be applied a
few at a time, and as these take hold others
added, until the whole number directed have
fastened upon the part. As each fills, he lets
go his hold and falls off; but if from any cause
it is desired to remove them, or any of them,
sooner, they may be made to let go their hold
by putting common salt upon them. The leech
should not be pulled off by violence, lest a
portion of its head be broken off and remain
in the wound, thus causing unnecessary irrita-
tion and killing the animal.
The American leech may be estimated as
drawing about a drachm of blood, or even a
little more : from six to eight will represent an
ounce. The European leech is much larger,
and may be estimated at two or three to the
ounce of blood.
After the leeches are removed, bleeding may
be encouraged, if so directed, by applications
of warm water or of a warm poultice, or it
may be checked, after carefully washing the
part with cold water, by simple exposure to
the air. Sometimes, however, the bleeding is
quite profuse, and may resist this simple
measure, in which case a sharp-pointed stick
THE HOSPITAL STEWARD'S MANUAL. 319
of nitrate of silver, introduced into the little
bleeding orifices, will generally be found
efficient.
Leeches may be kept on hand in good con-
dition, for a long time, in tubs filled with
water, at the bottom of which turf or peat is
placed : the water should be changed about
once a week. After they have been used, some
means should be employed to evacuate the
blood they have gorged : otherwise, they gene-
rally die. This may be done by sprinkling
them with salt, or pouring salt water upon
them, which causes them to eject the contents
of their stomachs. A better plan, perhaps, is
to make with a thumb-lancet two small punc-
tures on the back of the leech, one on each
side of the median line : through these the
blood escapes, and the little wound subse-
quently heals. After using, leeches should be
kept in a vessel separate from the others for
two or three weeks, after which those which
survive may be again employed.
SECTION III. EXTRACTION OF TEETH.
For the extraction of teeth, a case of dental
instruments is furnished with the medical sup-
320 THE HOSPITAL STEWARD'S MANUAL.
plies. This case contains a gum-lancet, forceps,
a key, and an elevator.
The Gum-Lancet is used prior to grasping the
tooth with the extracting instrument, for the
purpose of separating the gum from the tooth.
Forceps of three shapes only are usually fur-
nished,— one straight, for the incisors and cus-
pids; one curved, for the bicuspids and molars,
and one with pointed blades, for the extrac-
tion of stumps.
The Key is usually furnished with two or
three movable claws, so as to accommodate
both sides of either jaw, and large as well as
small teeth.
The Elevator is simply a lever with a sharp
notched extremity, which is used in the ex-
traction of stumps.
In the extraction of teeth by the forceps, the
gum of the tooth to be removed is first well
separated by means of the gum-lancet. Then
the tooth is grasped by the forceps, taking care
to apply the blades well down upon its neck,
as near as possible to the alveolar process. The
forceps are to be closed upon the tooth firmly
enough to prevent them from slipping, but not
with such force as to crush it, — a precaution
especially to be attended to if it is much de-
THE HOSPITAL STEWARD'S MANUAL. 321
cayed. In the extraction of the incisors, the
cuspids, and the bicuspids, a slight movement
of rotation is now to be made, having for its
object to loosen the tooth from its connections
before exerting the traction which is to extract
it. In the case of the molars, however, as rota-
tion would be likely to break one or more of
the fangs, a lateral, rocking motion is to be
substituted.
The extraction of teeth by the hey should not
ordinarily be practised: it is a clumsy instru-
ment, and is liable to break the teeth, bruise and
lacerate the gum, and do other mischief. Occa-
sionally, however, with the limited supply of
dental instruments furnished to the hospital
steward, its use may become necessary, espe-
cially in cases where the tooth is in such a
state of decay as not to offer a good hold to the
grasp of the forceps.
In the use of the key, the gum having been
well separated, the claw is to be adjusted so
that its point is well pressed down between the
gum and the neck of the tooth ; the handle oi
the key is then turned so as to bring the ful-
crum against the gum on the opposite side, and
the tooth grasped in this way is to be lifted
perpendicularly, or nearly so, from its socket.
322 THE HOSPITAL STEWARD'S MANUAL.
SECTION IV. INJECTIONS.
JEnemata, or injections by tJie rectum, may
be directed by the surgeon not merely to pro-
cure the action of the bowels, but for various
medicinal purposes.
The beak of the syringe or enema-pump
should be warmed and well anointed with oil
or lard. It should be gently and cautiously
introduced, especially where the patient suffers
from piles, or other diseases of the rectum; the
fluid should be thrown in gradually and without
violence, and, when the quantity directed has
been introduced, a few moments should be per-
mitted to elapse before the beak is withdrawn,
lest on its too rapid removal the fluid, or a
part of it, should escape with it.
A large syringe, made of hard India-rub-
ber, is furnished with the medical supplies for
this purpose. Where bulky enemata are di-
rected, however, it will be found better to use
the force-pump, which is furnished among the
medical supplies with attachments by means
of which it may be used either as a stomach-
pump or for injection.
THE HOSPITAL STEWARD'S MANUAL. . 323
With this apparatus a steady and continu-
ous stream may be thrown in. Printed di-
rections for its use accompany the instru-
ment.
The ordinary injection to procure the eva-
cuation of the bowels consists of a tablespoon-
ful of common salt and the same of molasses
dissolved in a pint of warm water. This is
what is generally understood when a patient
is directed to have "an injection." The com-
position of any other enema must be specially
directed by the surgeon.
Injections hy the urethra are frequently em-
ployed, especially in cases of gonorrhoea. For
this purpose, small syringes of hard India-
rubber, or of glass, containing about half an
ounce, are furnished with the medical supplies.
The syringe being filled, its beak is to be oiled
and introduced very gently into the urethra,
and held in position by the thumb and last
three fingers of the right hand, while the piston
is pushed down by the right forefinger, the
left hand being meanwhile employed in sup-
porting the penis in position.
Various solutions are employed in this man-
ner. None of them, however, should ever
be resorted to except on the prescription of
324 THE HOSPITAL STEWARD'S MANUAL.
a medical officer. In any case, it will be
generally found advisable to wash out the
urethra by the use of a syringeful of luke-
warm water, before throwing in the medicated
solution.
THE END.
Date Due
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Ptilj/^ General for use in Hospitals of the United States Army. By Jo
Janvier Woodward, M.D. , Assistant Surgeon U.S.A. l2mo. '
Leidy's Anatomy. Human Anatomy. An Elementary Text-Px
Students. By Joseph Leidy, M.D., Professor of Anatomy L
University of Pennsylvania. One vol. 8vo. Elegantly illustrated
from original designs. Sheep. $5.00.
Longmore on Gunshot Wounds. Longmore's Gunshot Wounds. A
Treatise on Gunshot Wounds. By T. Longmore, Deputy Instructor
of Hospitals, Professor of Military Surgery at Fort Pitt, Chatham.
In two parts. Part I., Gunshot Wounds in General. Part II., Gun- '
shot Wounds in Special Regions of the Body. One vol. 12mo. 75 ets.
Malgaigne's Fractures. A Treatise on Fractures. ByProf. Malgaigxe,
of Paris. Translated from the French by John II. Packard, M.D. "
i" 'Hiii Hi
8vo, with numerous illustrations. $4.00.
Gerhard on the Chest. The Diagnosis, Pathology, and Treatment S
of the Diseases of the Chest. By W. W. Gerhard, M.D., Fellow of
the College of Physicians of Philadelphia, Member of the American
Philosophical Society, and one of the Physicians to tho Pennsylvania
Hospital, &c. Fourth edition, revised and enlarged. One vol. 8vo.
Cloth, $3.00; sheep. $3.23.
B. LIPPINCOTT & CO., Publishers,
PHILADELPHIA.
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